ANNEX LEAVE FORM

Date:_____________________

Dear Teacher,

My son/daughter_______________________________ (name) will be leaving early from school on __________________________(date) for a ___________________________ appointment. 

Please dismiss them to the office no later than_______________ (time).  I understand that my child will miss: ____________________________________________________________(class/classes).  *I fully understand that my child may not miss the same class/course more than 16 times in a school year without risking loss of credit for that class/course.  Students who leave for more than 2 hours in a day are counted absent for a half a day.

(Please check one)  

Leaving early will not return

Leaving from school but will return before the end of the day

**Students who submit this letter the day before the appointment may ask the teacher(s) for the assignments they will miss the next day.  Students who submit this note the day of the appointment may get their assignment(s) from the missed classes as you would any other absence.

Please be sure your child returns with a doctor’s note on the following day and that it is submitted to the classroom teacher.  Failure to do so may result in an unexcused absence.