IRCHS | Absence Form

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– EXCUSED ABSENCE REPORTING –

This form is for Excused Absences ONLY (9 Medical or 6 Parent)

MEDICAL: Note Required - 9 days total (over 9 days must meet w/ admin)
PARENT/LEAVE: Reason needed - 6 days total (over 6 days requires a contract/meeting)

This form must be submitted at most 3 days after the absence.

PLEASE NOTE: DUE TO THE UNIQUE SCHEDULE OF IRCHS, WE ALSO TRACK TOTAL NUMBER OF PERIODS IN EACH CLASS INCLUDING BLENDED HOURS.

Student First Name

Student Last Name

Student Grade*

Student ID

Parent / Guardian's Name*

Parent / Guardian Email*

Parent Cell Phone*

Absence Start Date*

Absence End Date*

Reason*

Medical - Excused up to 9 days a semester - Medical Note Required below

Parent/Leave - Excused up to 6 days a semester - Parent Note Required Below

Periods Missed*

Period 1 - 7:30 am - 8:20 am

Period 2 - 8:25 am - 9:15 am

Period 3 - 9:20 am - 10:10 am

Period 4 - 10:15 am - 11:05 am

Period 5 - 11:50 am - 12:40 pm

Period 6 - 12:45 pm - 1:35pm

Period 7 - 1:40 pm - 2:30 pm

Period 8 - 2:35 pm - 3:38 pm

Reason*

Please indicate the type and reason for the absence

By signing below, you confirm that you are the parent or guardian of the student listed above.

Please note that students who exceed the permitted number of absences per semester will have their course credit withheld and will not receive a final grade.

Once your verification is processed, you will receive an email update regarding the

Signature*

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Medical Note (if applicable)

Confirmation Email*

INDIAN RIVER CHARTER HIGH SCHOOL

6055 College Lane, Vero Beach, FL 32966

(772) 567-6600

SITE: DESIGN BY T.E.G.

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