Clark Intermediate Absence Form

Absences may be verified by phone.

Child's Name Child's Name * First Last
Parent/Guardian Name Parent/Guardian Name * First Last
Contact Phone Contact Phone * - ### - ### ####
Contact E-mail *
Date(s) of Absence *
Reason for Absence *

Please provide Dr.'s note when applicable.
Request Homework? *

Request Homework? Yes No

By choosing "yes" your student's homework will be collected from all teachers and will be available to pickup from the Clark Main Office between 2:30 p.m. and 4:00 p.m.
Notes or Explanation