B.H.H.S. MUSIC DEPARTMENT

ABSENCE(S) FORM

Please complete all pertinent items and return to your director(s). Should absences occur without your completing absence forms, the director will contact you for appropriate resolution. Please note that the resolution may result in your not being able to participate in a performance, which may consequently have an impact on your quarter grade.

· For items 4, 6, and 7, this form must be completed and returned to the respective director(s) four weeks prior to the absence.

· If absence was for illness, an emergency, or bereavement, this form should be submitted to the respective director(s) immediately upon return to school.

Name of Student: ___________________________________________ Grade: ______________

Ensemble(s) missed: _______________________________ Rehearsal ____ Performance ____

CIRCLE PORTION MISSED: ENTIRE EVENT FIRST HALF SECOND HALF

Date Submitted: __________________ Date(s) of Absence: __________________________

My Absence(s) should be charged as follows:

1. ____ Student Illness

2. ____ Family Illness (Relationship: ________________________)

3. ____ Emergency (attach explanation)

4. ____ Appointment (Doctor/Dentist, etc.) which could not be scheduled

for any other time. Appt. time: _____________________

5. ____ Bereavement (Relationship: _________________________)

6. ____ Wedding/Graduation (Relationship: ____________________)

7. ____ Other. Explanation: ________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________

Signature of Student: ________________________________________ Date: _______________

Signature of Parent: _________________________________________ Date: ________________

Signature of Director: ________________________________________ Date: ________________

FOR DIRECTOR’S USE:

£ EXCUSED

£ UNEXCUSED _________________________________________________________

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