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Medical Absence Reporting

This form is to upload medical absences ONLY. For absences that do not warrant a doctor's visit, please see the unexcused absence section of the IRCHS Attendance Policy. Student leave forms can be picked up in the front office and must be submitted 3 days prior to the absence.

Student's Name*

Answer Required

Student Grade*

Answer Required

Student ID*

Answer Required

Parent / Guardian's Name*

Answer Required

Parent/ Guardian's Email*

Answer Required

Absence Start Date*

Answer Required

Absence End Date*

Answer Required

Medical Reason*

Answer Required

Upload Medical Note*

Answer Required

Choose a file or drag it here.

Confirmation Email

Email Required