Vacation Request Form

How many students?

Student 1 First Name

Last Name

Grade

Homeroom Teacher

Student 2 First Name

Last Name

Grade

Homeroom Teacher

Student 3 First Name

Last Name

Grade

Homeroom Teacher

Student 4 First Name

Last Name

Grade

Homeroom Teacher

Student 5 First Name

Last Name

Grade

Homeroom Teacher

Student 6 First Name

Last Name

Grade

Homeroom Teacher

Start Date

End Date

Reason for Absence

Primary Parent/Guardian Name

Primary Parent/Guardian Email

Primary Parent/Guardian Phone

Second Parent/Guardian Name

Second Parent/Guardian Email

Second Parent/Guardian Phone

I acknowledge and agree...

My child(ren) will be missing at least one full day of school, and this may be a barrier to formal education.
It is my responsibility, as the parent/guardian, to ensure my child(ren) are caught up on their work within a reasonable time of return.
Teachers will give their best effort at providing work and assisting students with learning missed, but may not be able to provide this until the day after return.
The standard amount of time to catch up on missing homework without penalty is equal to the number of days absent.
I will communicate with teachers to ensure this commitment is met, and if I have any questions.

Parent Name (Serves as Signature)

Today's Date