Extended Absence Form

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This form is required for any absence that will extend past 2 days of school for personal reasons or past 4 days for illness. Please fill out this form and communicate with your teachers PRIOR to your absence if possible.
THIS FORM SHOULD ONLY BE FILLED OUT BY THE PARENT/GUARDIAN. The email that submits this form will be recorded. If it is not the parent/guardian's email address, the student will be marked with unexcused absences for the time period.

If the absence is due to illness, surgery, or anything medical, please also email a doctor's note to
rbauman@dcsdk12.org.

Email *

Student's Name *

Today's Date *

YYYY

Grade of Student *

9th

10th

11th

12th

Reason for absence *

Travel

Sports/Activity

Illness

Surgery

Other:

Any Information you want to give regarding the absence: *

Start date of absence *

YYYY

Final date of absence *

YYYY

Has the student been in contact with ALL of their teachers and know what is expected prior to leaving and upon their return? *

Yes (By marking "yes" the student is responsible to follow the instructions/expectations put forth by their communication with their teachers in completing assignments and acquiring missing notes/work. If you mark yes and there was not communication made with teachers, the student may not be allowed to submit work at times that are past the original due dates or make up missed assignments/quizzes/tests)

No (A student's absence will not be excused without communication with their teachers or a doctor's note being provided.)

The student and parent(s)/guardian(s) are aware of the student's current grades and have communicated with teachers any questions or concerns. (You can always view and access grades on Canvas and Infinite Campus in the student and parent portals.) *

Yes

Name of parent/guardian filling out form *

Contact information in case we have any questions *

Signature of parent/guardian (By typing your name you are acknowledging that you are the legally responsible adult for the listed student. Your email address will be recorded with the submission to match that of the legal parent/guardian of the listed student.)

Send me a copy of my responses.

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