CCS Absence Request

Absences that are planned in advance must be pre-approved by the administration. Pre-approval via the Absence Request Form should be requested at least one week in advance. Please consult the CCS Events Calendar (website and ParentsWeb) when planning medical and dental appointments.

Date Submitted

- Month - Day Year

Parent/Guardian Email *

Student Name *

First Name Last Name

Grade *

Start Date *

- Month - Day Year

Is this absence for more than one day in a row?

No Yes

End Date *

- Month - Day Year

Is this a recurring event (i.e. "every Tuesday at 1:00")?

No Yes

Please list all recurring dates:

The administration will determine whether an absence is excused or unexcused according to the guidelines set forth in the Parent Handbook. Unexcused absences invoke academic and disciplinary consequences. Please refer to the Parent Handbook. A student receives a detention after five counts of unexcused tardiness.

Type of Request *

Appointment Time *

: Hour Minutes

Student Dismissal Time *

: Hour Minutes

Student Dismissal from School Time

: Hour Minutes

Student Arrival Back to School Time

: Hour Minutes

Reason for Request *

Illness Medical appointment Dental appointment Personal injury Death of a relative Once-in-a-lifetime event: e.g., wedding/funeral of a family member (explain below) College visit: juniors/seniors only (list college below)

Explanation *

Would You Like Your Child's Work Early? *

Yes No

I hereby accept full responsibility for my child’s absence, realizing that it interrupts his regular instructional program. I agree to take all necessary steps to make arrangements for the completion of all work missed.

Parent/Guardian Signature *

Clear

Office Use Only

Official