FSUS Prearranged Absence Parent Permission Form

Parents/Guardians Submit Prearranged Student Absences

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Fill out the following form with all appropriate information:
(Fields highlighted with * are required.)

* Student name:	,
	Last, First MI
* Grade level:
Enter the following information about your child's prearranged absence:
* Date leaving school:	at (time)
* Date returning to school:	at (time)
* Reason for absence during school year (if trip, to where?):
Should we need to contact you regarding submission of this form, please enter contact information:
* Phone number:

Sign below (by typing your name) to verify that the above information is correct:
Note: Submitting this form by any person other than the legal parent/guardian of a child could result in school disciplinary and/or legal action against that person.
* Signature:
Date of submission:	11/23/2009, 6:05:58 AM