JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Absence Excuse Form
***Absences past 3 days for illness must provide a medical note***
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Student's Name
*
First and Last
Your answer
Student's ID Number
Your answer
Section
*
51
61
62
71
72
81
82
83
108
Parent / Guardian's Name
*
Your answer
Parent / Guardian's Phone Number
*
Your answer
Parent / Guardian's Email Address
*
Your answer
Date of Absence(s)
*
Your answer
Reason for Absence(s)
*
illness
Death in the immediate family
Medical or Dental Appt.
Court or Administrative Proceedings
Religious Observance
Other:
Illness Symptoms
*
Sore Throat
Headache
Fever
Stomach Ache
Nausea
Vomitting
Diarrhea
Cough
Runny Nose
Body Ache
Other:
Required
IF YOU HAVE ANY OF THE ABOVE SYMPTOMS PLEASE CALL THE SCHOOL NURSE AT THE NUMBER BELOW BEFORE RETURNING TO SCHOOL.
Nurse Collier (215) 400-4210 OPTION 2
Board of Education Policy 204-Student Attendance
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of School District of Philadelphia.
Report Abuse
Forms
