Absence Form for Medical, Dental or Optical Appointment

Please complete this form to inform us of an appointment your child has during the school day.

Name of Child

First Name

Last Name

Class

I would like my child to be granted leave of absence from school for the following reason

Medical appointment

Dental appointment

Optical appointment

Date of appointment

YYYY

Time of appointment

Hour

Minute

Second

I would like to collect my child from school at

If the appointment is at the start of the school day, please put the time as 8:30am.

Hour

Minute

Second

If your child will miss morning registration, please confirm their lunch choice below:

Parent completing form

First Name

Last Name

Date form completed

YYYY