FSUS Prearranged Absence Parent Permission Form

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For parents/guardians submit prearranged student absences

Fill out the following form with all appropriate information:
(Fields highlighted with a * 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:	8/7/2008, 4:19:26 PM