EmailMeForm
Middle School Absence Request Form
REQUEST FOR STUDENT ABSENCE
EXCUSE FOR STUDENT ABSENCE
This form must be used to excuse a student for one or two days of sickness.
Remember, one or two days of sickness may be excused by a parent using this form, while 3 or more days must be excused with a verified doctor’s note.
Northlake Christian policy states that students may miss ONLY 10 days in a year, except in the case of extenuating medical or family emergency circumstances which have to be approved by the administration.
Student Name
First
Last
Student's Grade
5th
6th
7th
8th
Name of Parent Filling out this form
First
Last
Parent's Email
Parent's Phone
###
-
###
-
####
This is a:
Request for FUTURE absence
Excuse for PREVIOUS absence
Beginning Date of Absence
MM
/
DD
/
YYYY
Ending Date of Absence (if applicable)
MM
/
DD
/
YYYY
Absence Reason (please give as much detail as possible)
By checking this box, I certify that this absence is verified for the reason above. This checkbox serves as your electronic and binding signature.
Electronic Verification
This request for absence will be sent to the appropriate administrator for approval.