Clark Intermediate Absence Form
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
Illness - Dr.'s Note
Illness - No Dr.'s Note
Family Emergency
Out of Town
Other - Please Explain
Please provide Dr.'s note when applicable.
Notes or Explanation