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MARYVALE PRIMARY SCHOOL
EXCUSE FORM
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* Indicates required question
Student's First & Last Name
*
Your answer
Grade
*
Pre-K
Kindergarten
1st
2nd
Homeroom Teacher / Room Number
*
Your answer
Absence Date(s) List extra dates under REASON
MM
/
DD
/
YYYY
Tardiness Date and Time
MM
/
DD
/
YYYY
Time
:
AM
PM
Early Release Date and Time
MM
/
DD
/
YYYY
Time
:
AM
PM
Please write the reason for absence, tardiness or early release. Also add extra dates here. Please be specific:
*
Your answer
Parent or Guardian Electronic Signature and Date:
*
Your answer
To ensure safety of our students please make sure submit any changes by 1:00PM regarding any dismissal changes.
*
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