Vacation Request Form
Student Name:
___________________________ Today’s
Date: _____________
Parent Name:
____________________________ Phone
#: _________________
|
Homeroom Teacher: ______________________
Date/s Vacation is scheduled:
Students are permitted up to [ ] days of excused vacation per year with the following limitations.
·
The
vacation request must be submitted on this form a minimum of [ ] days
prior to the first day of the scheduled vacation.
·
Student
must complete all work assigned by teacher while gone on vacation. The
work is required to be turned in on the day the student returns from vacation.
The child’s teacher will sign off on this form and return to the building
principal indicating whether all work has been completed. When all work is
completed the vacation days will receive final approval by the principal. If
all work is not completed then the vacation days will not receive final
approval and the absences will be considered to be unexcused.
·
If a
student has already had [ ] or more days of absence (excused or unexcused) in
the semester that the vacation day(s) are requested then the vacation request will
not be approved.
- Vacation
days that are requested during required state testing will not be
approved.
Parent Commitment:
I have read and
understand the limitations for vacation day requests. In signing this form
requesting vacation, I assure that my son/daughter will complete all work
provided by the teacher while he/she is absent from school.
_______________________________________ _____________________________
Parent
Signature Date
-- Do Not Write Below this Line –
(For Office Use Only)
Days of excused
absence this semester: ______ Days of
unexcused absence this semester:
Teacher
Signature upon receipt (date) Principal
Signature upon receipt (date)
£ All work complete ________ £ Final approval if work is completed
£ Work not complete ________ £ Vacation request not approved
