Long-Term Absence Report

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(For Absences of Three or More Days)
This form is to be completed by Guardian and Teacher prior to the planned absence. It will become part of the student’s permanent file.

Email *

Student Name *

Teacher: *

Reason for Absence *

Dates of Planned Absence *

- I understand the impact that this absence may have on my child’s education

I Understand

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Our staff will do their best to provide resources for your learner while they are out. If it is for more than 10 days, please plan on giving supplemental work for your learner beyond what we can provide. Hearthside Books and Costco have great grade-level workbooks that can help keep your learned engaged with grade-appropriate activities while you are out!

I Understand

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We encourage families to please check the Seesaw and Canvas regularly to stay up with the flow of the class.

I Understand

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We can provide a Chromebook if your family needs one while you are out.

Yes, I need one

No, I have my own way to access the Internet

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Staff is not obligated to zoom in with your learner while you are gone on a trip.

I Understand

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- I have consulted the Assessment Calendar on the District website and (if the absence coincides with State mandated testing dates) have made arrangements for off-site testing or signed a parent refusal form.

YES

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Parent Signature (type full name to sign) *

A copy of your responses will be emailed to the address you provided.

Submit

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