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 of Absence

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 symptom or multiple choice) Please note, after 3 days or more of absence, a medical clearance note provided by a locally licensed Doctor is required upon the student's return.

Reasons 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/Guardian Name

Parent/Guardian 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

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

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