Dear : Attendance Office Sister Father Brother Ms. Mrs. Mr. Dr. To Whom It May Concern Teachers name:                                     

From:       January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2007 2008 2009 2010
          Parent or guardians name:

Students Name:

Reason for note: Other Has an orthodontist appointment at Is late due to Has a doctors appointment at Has a dentist appointment at Will be picked up by Will be going home with Is returning to school after an illness lasting  
                         
                      
                               
                          Please print pick up persons name: 

And will be picked up at: ---- 7:30 7:45 8:00 8:15 8:30 8:45 9:00 9:15 9:30 9:45 10:00 10:15 10:30 10:45 11:00 11:15 11:30 11:45 12:00 12:15 12:30 12:45 1:00 1:15 1:30 1:45 2:00 2:15 2:30 2:45 3:00 3:15 3:30 3:45 4:00 4:15 4:30 5:00 At dismissal                ---- 8:00 8:15 8:30 8:45 9:00 9:15 9:30 9:45 10:00 10:15 10:30 10:45 11:00 11:15 11:30 11:45 12:00 12:15 12:30 12:45 1:00 1:15 1:30 1:45 2:00 2:15 2:30 2:45 3:00 3:15 3:30 3:45 4:00 4:15 4:30 5:00 At dismissal
                                        Time                                Date:  month/day/year                  Will return at:

       
Thank you, __________________________         ______________
                    Parent or guardian's signature:                     Date:

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