* Required

Please use this form to report an absence, a late arrival, or an early dismissal.

You may follow up with an email to the School Nurse to provide further details and, if sick, to be cleared to return to school after an illness.

Student's First Namerequired

Student's Last Namerequired

Student's Teacherrequired

Date of Absence/Early Dismissal/Late Arrivalrequired (mm/dd/yyyy)

Are you reporting an absence, late arrival, or early dismissal?required

Time of Late Arrival or Early Dismissalrequired

Will this be an extended absence?*

Yes No

What dates will your child be absent?required

Reason for Absencerequired

If it is an illness, please name the illness. If it is unclear, please list the symptoms and when they began.

Reason for late arrival or early dismissalrequired

Please list the reason for your late arrival, (For example, a special outing, a doctor or dentist well visit, etc.)

I understand that I must receive clearance from the School Nurse prior to my child returning to school when they are absent, late, or leaving early due to an illness.*

Please contact our School Nurse, Susan Ballas (sballas@gladwyne.org), and make sure to receive clearance from her prior to your child returning to school, if they are absent due to any illness.

Please send a confirmation email to the address below*: