Baker Elementary School

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Absence Form

Please complete the form below to report your students absence. Required fields marked with an asterisk *

Student Name ( First and Last)*

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Parent/Guardian Name (First and Last)*

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Grade*

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TK

Kindergarten

1st

2nd

3rd

4th

5th

Students Teacher*

Room or Name

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Date of Absence*

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Reason for Absence*

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Illness or Injury

Medical or Dental Appt. (Bring note when you return to school)

Observation of Religious Holiday

Other:

Confirmation Email

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Baker Elementary School

Moreland School District

4845 Bucknall Road, San Jose, CA 95130 Phone: 408-874-3200 Fax: 408-379-3726 Attendance Line: 408-874-3210

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