Lewisburg High

1) Students' Legal Name Required*

2) Date of Absence(s): Required*

3) School: Required*

4) Homeroom Teacher: Required*

5) Please Excuse (type student's full name) Required*

6) Please check the absence reason that applies: Required*

Illness/Injury

Death or serious illness of immediate family member

Court appearance

Other reason

7) If "other reason" please type an explanation below: Required*

Please read

This excuse must be received within 2 days of your child's absence. If an excuse is not received in the required time, the absence will be considered unexcused.

If you have any questions, please contact the Attendance Clerk, at the school.

8) Parent Signature Required* Signature

I understand that my typed signature is the legal equivalent of my handwritten signature on this document.

Lewisburg High

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