ABSENCE FORM

ABSENCE FORM
Student Information
Full Name

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

First Name Last 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.

Fever Chills Congestion or runny nose Cough Shortness of breath Difficulty breathing Diarrhea Nausea_Vomiting Fatigue Headache Sort throat Muscle or body aches New loss of taste or smell Stomach pain
Expected Return Date *

Month Day Year
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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