Student: ________________________________________

Class: ___________________________________________

Reason for absenteeism: (please tick)

    –  Ill

    –  Family reason

    –  Exemption for extended family holiday

(must provide letter with details / dates to the front office)

Period of time absent:

    –  All day                              – Morning

    –  Afternoon                         –  Early Departure

Other details: ____________________________________

Parent/Guardian signature: _________________________