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Absence Verification Form

Please use the following form to clear your child's absence(s). If you have a doctor's note please bring it to the main office or upload a copy below. If you have any questions you may call the main office at (818) 224-4430.

Student's First and Last Name*

Answer required for "Student's First and Last Name"

Student's Date of Birth*

Answer required for "Student's Date of Birth"

Student's Grade*

Answer required for "Student's Grade"

Teacher's Name*

Answer required for "Teacher's Name"

Room Number*

Answer required for "Room Number"

Absence Date*

Answer required for "Absence Date"

Reason for Absence*

Answer required for "Reason for Absence"

Illness

Doctor/Medical Appointment

Funeral

Other

Please explain reason for absence.*

Answer required for "Please explain reason for absence."

If you have a doctor/dental note, please upload a copy here.

Answer required for "If you have a doctor/dental note, please upload a copy here."

Choose a file or drag it here.

Parent/Guardian's First and Last Name*

Answer required for "Parent/Guardian's First and Last Name"

Parent/Guardian's Signature*

Signature Required

Parent/Guardian's Email*

Answer required for "Parent/Guardian's Email"

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"