2. Parent/Guardian Name*
4. Child Name*
6. Grade*

   1. Kindergarten
   2. First Grade
   3. Second Grade
   4. Third Grade
   5. Fourth Grade
   6. Fifth Grade
8. Date(s) of absence*
10. Phone number where parent/guardian can be reached*
12. Any comments or feedback?
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13. 1. Receive an email copy of this form.
14. Email address

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15. Submit

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