Attendance Form | Fairfax Academy

Date of Absence

Please check this box, if you are choosing to report consecutive day absences

Please list the consecutive absence dates

Student's First Name

Student's Middle Name

Student's Last Name

Grade

Course

Feeder School

Reason for Absence

If reporting an ill student, include symptoms, especially if they have fever, nausea, vomiting, sore throat, and/or cough. If your student has a diagnosis from a healthcare provider, please include that information.

Parent/Guardian Contact Information

Parent/Guardian First Name

Parent/Guardian Last Name

Phone Number

Alternative Phone Number

Parent/Guardian Email Address (must be email address listed in SIS for parent)

Confirmation

By submitting this form, you are confirming that you are the parent or legal guardian of the student

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Parent/Guardian Contact Information