School Readiness Child Absence Note

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Parent Name

First

Last

Parent Email

Parent Phone Number

Child's Name

First

Last

to box Parent

(Optional) Use this box to add name(s) of additional child(ren) covered by this note

Dates of Absence

Reason for Absence

List the extraordinary circumstances in which ELC shall approve for the excessive absences beyond three days for the month. Extraordinary circumstances do not include vacation or recreation. Total monthly reimbursed absences should not exceed thirteen (13) calendar days

Parent Signature

Clear Signature

By signing below, I acknowledge and agree that my electronic signature is the legal equivalent of my manual signature. I consent to be legally bound by the terms and conditions outlined in this document through the use of my electronic signature.