Absence Excuse Note Form – St. Luke’s Academy

Please excuse my child/ward,

Name of Student

Enrolled in

Missing

has missed
will be missing school on

Date(s) fo Absence

From

To

due to the reason(s) checked below:

Please select the reason(s) why your child/ward missed or will be missing school:

If you have selected "illness" please provide details and symptoms.

If selected, please indicate illness from the drop down menu

Student illness/sickness

List of Symptoms

(Required to click at least one sysmptom or mulitiple choice) Please note, after 2 days or more of absence, a medical clearnace note provided by a locally licensed doctor is required upon the student's return.

Reason for Absence

Scheduled Appointment
Emergency Appointment
Travel
Religious holiday
Bereavement
Injury or Accident
Other (If you selected "other", please provide details. Please understand that under the policies of St. Luke's Academy and the Ministry of Education, only certain absences may be accepted as excused absences.)

Other Details

Parent's/Guardian's Name

Parent's/Guardian's Phone Number

Email

Today's Date

**Note to Parents/Guardians: Please be aware that excuse notes must be turned into school staff within two (2) days following a student’s return from an absence for the absence to be excused.

St. Luke's Academy

Inspiring Excellence

Date(s) fo Absence

Please select the reason(s) why your child/ward missed or will be missing school:

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