Therapy Schedule Update
Parents: Please complete this form for any absences (illness, vacations, appointments, etc.)

Each year your child is allowed 12 days of unexcused absences.
Unexcused absences include calling in sick or cancelling a session with less than 2 weeks’ notice.

Excused absences include scheduled absences with more than 2 weeks’ notice, or calling in sick and providing a doctor’s note.
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Email *
Which center does your child attend? *
Name of child *
Name of parent/caregiver completing form *
Please indicate reason for absence: *
If your child is ill, please indicate general symptoms below:
Dates of absences *
Total number of days absent (can use half days) *
Please keep in mind that for illness, we require 24 hours fever free, vomit free, or diarrhea free, without medication, prior to returning. Date returning to therapy: *
MM
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DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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