ABSENCE FORM

ABSENCE FORM
Student Information
Full Name

First NameLast Name
Grade*
Parent / Guardian Information
Parent / Guardian Name*

First NameLast Name
Email Address*
example@example.com
Phone Number
Absence Detail
Reason Why? If your student is out ill today, please check the symptoms your student is experiencing. Please check all that apply.

FeverChillsCongestion or runny noseCoughShortness of breathDifficulty breathingDiarrheaNausea_VomitingFatigueHeadacheSore throatMuscle or body achesNew loss of taste or smellStomach painVacationOther
Vacation Start Date (for Vacation notification only)
Expected Return Date*

MonthDayYear
Date
Homework Request (Grades 1st to 6th)
Parent / Guardian Signature*

Clear
High Point Academy | 1720 Kinneloa Canyon Road, Pasadena, CA 91107 | (626) 798-8989
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