Absence Request Form

Student safety our a priority.

Please fill this form out three weeks prior to an absence. Communication in a timely manner is the key to resolving any conflicts that may arise through understanding and compromise. If there is an emergency please contact Mr. Thomann via email (jonathan.thomann@berkleyschools.org) at the next convenient opportunity.

Student

First Name

Last Name

Berkley Community Schools Email Address

Parent/Legal Guardian Email Address

Phone

Emergency Contact

(###)

###

####

Requested Absence Date

If multiple days a separate request must be filled out. This includes late arrivals and early dismissals.

YYYY

Time

Hour

Minute

Second

Reason for Request Absence Request