ELEMENTARY SCHOOL EXCUSE NOTE
Please fill out and submit this form when your child is absent.
Please explain why your child was absent. Documentation must be received within 2 days of
your child returning to school. If your child is out 5 or more consecutive days, a note from
his/her doctor must be brought in. After 3 days with no note your child’s absence will be marked
as unexcused.
My child,__________________________________________, was absent from school on:
List specific dates_______________________________________________________________
Specific reason for absence________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Parent’s signature _______________________________________________Date____________
Homeroom Teacher _____________________________________________Date____________
Principal’s signature _____________________________________________Date____________
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FOR OFFICE USE ONLY
Date received _____________
Was excuse note received within 2 days of absence? Yes No
Was note from doctor received for 5 consecutive absences? Yes No
Attendance Secretary entered in Power School: Excused Unexcused (initials) ____________