Absence / Late Arrival / Early Dismissal Form

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.

Submitter Namerequired

First Name

Last Name

Submitter Email Addressrequired

How many students are you reporting absent, late, or early dismissal for the same reason (e.g., two children with the same illness, sibling doctor/dentist appointments, or family vacation)

Student's First Namerequired

Student's Last Namerequired

2nd Student's First Namerequired

3rd Student's First Namerequired

4th Student's First Namerequired

Date of Absence/Early Dismissal/Late Arrivalrequired

Must contain a date in MM/DD/YYYY format

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

Time of Late Arrival or Early Dismissalrequired

Will this be an extended absence?required

Yes

No

What dates will your child be absent?required

Reason for Absencerequired

List illness if known; symptoms if unknown

Reason for late arrival or early dismissalrequired

List reason: e.g. Doctor, Dentist, personal

Additional Note for Parents Reporting for Multiple Siblings:

Is there anything else the nurse should know?

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.required

I understand

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.

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Absence / Late Arrival / Early Dismissal Form

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