StMCS Absent Parent Form
Please complete this form if you will be away form your child(ren). This information will help the school and health office know who to contact in your absence.
Student Information
*
Dates I/We will be gone
*
Primary Contact During Parent Absence
Name
*
Relationship to Child(ren)
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Contact During Parent Absence
Name
*
Relationship to Child(ren)
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
If the Health Office needs to contact someone regarding my child(ren) for any reason (sickness, injury, etc.) please mark who should be contacted first
*
Parent/Guardian First
Designated Emergency Contact First
Parent/Guardian Authorization
Parent/Guardian Signature
*
Parent/Guardian Name
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: