CITRUS SPRINGS ELEMENTARY SCHOOL

Request for Change of Way Home/ Absence Excuse

CHILD’S FULL NAME:_________________________ TEACHER_____________

Please complete or check √ the appropriate information. Sign and date at the bottom of the form.

CHANGE OF WAY HOME REQUEST

Date(s) of Change______________

I will pick my child up at 3:15 PM at the 100 exit.____

I will pick up my child at the school office at ________(time.)

Child will be transported by________________________. This person is/ is not listed on the emergency card. I give permission for _____________________________ to transport my child. Signed __________________________________________

Parent Signature

Regular Bus #______Child will change to bus #________ to go to ________________ _________________________________________. (List day care, grandparent, or other destination)

Child will be picked up by car at 200 exit at 3:15 PM______.

Other:__________________________________________________________________

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EXCUSE FOR ABSENTEE

Dates of absence _______________

Reason for absence:

Illness__

Illness of family member__

Head Lice (excused 2 days only)____

Medical appointment___

Death in family____

Religious Holiday___

Natural Disaster_____

Educational trip___

A trip of an educational nature may be an excused absence only if prior approval from the principal is obtained. Submit an explanation of the trip, including dates, stating how it will be educational for the child.

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Signature Date

This form may be obtained from the school website at www.citrusspringselementary.com or the school office.