Child’s Name _______________________ Date ________________
Teacher ___________________________ Grade ______________

___Absent/Late My child ___ absent or ___ late on _____________due
to __________________________________________

___Appointment My child will be picked up at ______________ today for
the following reason _____________________________

___Permission My child has permission to go with ________________
today _______(date) _______ (bus)

___Change in Routine My child’s routine will change from ________________ to
______________________

Parent/Guardian Signature _____________________________________
Phone number where I can be reached ____________________________

Principal’s signature (if necessary) _______________________________