Excuse_Slip

Quakertown Community School District Quakertown Community School District

LEGAL FORM FOR ABSENCE, TARDINESS OR EARLY DISMISSAL Received by LEGAL FORM FOR ABSENCE, TARDINESS OR EARLY DISMISSAL Received by

Excuse is Due Within 3 Days from Absence Teacher on: ____________ Excuse is Due Within 3 Days from Absence Teacher on ____________



_______________________ Please _______________________

Please ______ ______

Excuse _____________________________________________________ Gr______ Rm ________ for:

Excuse _____________________________________________________ Gr ______ Rm ________ for: (print student name)

(print student name)

 Absence on ___________________________________________  Whole Day

 Absence on ___________________________________________  Whole Day (date)  AM Only

(date)  AM Only  PM Only

 PM Only

 Tardiness on ___________________________________ arrival time: ______________

 Tardiness on ___________________________________ arrival time: ______________ (date)

(date)

 Early Dismissal on _______________________________ dismissal time: ____________

 Early Dismissal on _______________________________ dismissal time: ____________ (date)

(date)

Reason: ______________________________________________________________________________

Reason: ______________________________________________________________________________



________________________________________________________ ___________________________

________________________________________________________ ___________________________ Parent/Guardian Signature Date

Parent/Guardian Signature Date

THE LAW REQUIRES A WRITTEN EXCUSE FOR EVERY ABSENCE, TARDINESS OR EARLY DISMISSAL WITHIN 3 DAYS OF THE OCCURRENCE.

THE LAW REQUIRES A WRITTEN EXCUSE FOR EVERY ABSENCE, TARDINESS OR EARLY DISMISSAL WITHIN 3 DAYS OF THE OCCURRENCE.









Quakertown Community School District Quakertown Community School District

LEGAL FORM FOR ABSENCE, TARDINESS OR EARLY DISMISSAL Received by LEGAL FORM FOR ABSENCE, TARDINESS OR EARLY DISMISSAL Received by

Excuse is Due Within 3 Days from Absence Teacher on ____________ Excuse is Due Within 3 Days from Absence Teacher on ____________

Please _______________________ Please _______________________

______

Excuse _____________________________________________________ Gr______ Rm ________ for: ______

Excuse _____________________________________________________ Gr______ Rm ________ for:

(print student name) (print student name)

 Absence on ___________________________________________  Whole Day  Absence on ___________________________________________  Whole Day

(date)  AM Only (date)  AM Only

 PM Only  PM Only

 Tardiness on ___________________________________ arrival time: ______________  Tardiness on ___________________________________ arrival time: ______________

(date) (date)

 Early Dismissal on _______________________________ dismissal time: ____________  Early Dismissal on _______________________________ dismissal time: ____________

(date) (date)

Reason: ______________________________________________________________________________ Reason: ______________________________________________________________________________



________________________________________________________ ___________________________ ________________________________________________________ ___________________________

Parent/Guardian Signature Date Parent/Guardian Signature Date

THE LAW REQUIRES A WRITTEN EXCUSE FOR EVERY ABSENCE, TARDINESS OR EARLY DISMISSAL WITHIN 3 DAYS OF THE OCCURRENCE.

THE LAW REQUIRES A WRITTEN EXCUSE FOR EVERY ABSENCE, TARDINESS OR EARLY DISMISSAL WITHIN 3 DAYS OF THE OCCURRENCE.