Editing previous response:

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Planned Absence Application

PLANNED ABSENCE FORM

The following must be completed in order to properly notify all teachers and office staff of any extended absence by the student.

If a student is absent for family holidays or for other non-medical reasons, the school and teaching staff are not expected to make special arrangements for missed work or tests. They may do so if they so choose. In any case, students will be held accountable and responsible for the learning outcomes missed. The responsibility for the decision to take a student out of school and the resulting consequences must rest solely with the student and the parent.

Student Name*

Answer Required

Student Grade*

Answer Required

Dates absent*

Answer Required

Return to school date*

Answer Required

Parent / Guardian Name*

Answer Required

Parent / Guardian Email*

Answer Required

Parent / Guardian Phone*

Number Required

Educational Agenda (please state briefly the elements of this trip that will be of educational value to your student)*

Answer Required

Attest*

Answer Required

I understand that I am responsible for any learning outcomes missed during this absence

I understand that if approved, a one page written summary of the trip must be written by the student upon return to school.