ABSENCE FORM
Student Information
Full Name
First Name
Last Name
Grade
*
Please Select
Kindergarten - Koral Talavera
Kindergarten - Lynette Wiebe
1st Grade - Genevieve Falchini
1st Grade - Mallin Altar
2nd Grade - Tori Dohlen
2nd Grade - Staycee Sciranka
3rd Grade - Sarah Marble
3rd Grade - Maria Salazar
4th Grade - Becky Lievense
4th Grade - Karla Yulo
5th Grade - Dahlia Martin
5th Grade - Rob Woodward
6th Grade - Sarah Nguyen
6th Grade - Robin Von der Lancken
7th Grade - Gint Valiulis
8th Grade - Colleen Zeiss
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
Vacation
Other
Vacation Start Date (for Vacation notification only)
Expected Return Date
*
-
Month
-
Day
Year
Date
Homework Request (Grades 1st to 6th)
Yes
No
Parent / Guardian Signature
*
Submit
High Point Academy | 1720 Kinneloa Canyon Road, Pasadena, CA 91107 | (626) 798-8989
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