Student Name
Parent Name
Parent Email
Parent Phone
Teacher Name
Grade	KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6
Date(s) of Absence	From  To
Reason for Absence	IllnessMedical AppointmentVacationFamily BereavementOther If other please specify:
A.M./P.M.	Absent A.M. OnlyAbsent P.M OnlyAbsent All Day
Additional Information

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