Absence Request Form

Absence Request Form

This form must be submitted if your child has exceeded the 12 allowed absences or if a planned absence will result in having over 12 absences from school. Submission of this request for excused absences does not ensure that the absence will be approved/excused. If you are requesting an absence approval for more than one child, please submit a request for each child individually. Please contact Melissa Dodder at mdodder@mitchellroadchristian.org with any questions.
Parent's Name*

First NameLast Name
Parent's Email Address*
example@example.com
Parent's Phone #*
Please enter a valid phone number.
Child's Name*

First NameLast Name
My child is in * grade and his/her homebase teacher is Type a label*.
Start Date of Absence*

MonthDayYear
Date
End Date of Absence*

MonthDayYear
Date
Reason for Absence*
Additional Comments
Parents- Please check each box below, indicating that you understand and agree to the absence guidelines below.*
Parent's Signature*

Clear
Today's Date*

MonthDayYear
Date
Should be Empty: