Lewisburg Middle

1) Students' Legal Name

2) Date of Absence(s):

3) Homeroom Teacher:

4) Please Excuse (type student's full name)

5) Please check the absence reason that applies:

Illness or Injury

Death or serious illness of immediate family member

Court appearance

Other reason:

6) If "other reason" please type an explanation below:

This excuse must be received within 2 days of your child's absence. If an excuse is not received in the required time, the absence will be considered unexcused.

If you have any questions, please contact the Attendance Clerk, at the school

Email the Attendance Clerk at lmsattendance@dcsms.org.

7) Parent Signature Signature

I understand that my typed signature is the legal equivalent of my handwritten signature on this document.

8) Date Signed

Lewisburg Middle

Forms