PRE-ARRANGED ABSENCE FORM - Bvsd

Horizons K-8 School, 4545 Sioux Drive, Boulder, CO 80303
PRE-ARRANGED ABSENCE FORM
Student Name: ___________________________________
Homeroom / Community: ___________________________
Date of Absences: ____________________
Number of days requested: _________
Reason for Request:
Elementary:
Homeroom Teacher Name Teacher Signature Date
Assignments due (To be completed by student):
Middle School:
Class / Teacher Name Teacher Signature Date
Community
LA/History
Math
Science
Spanish / Study Hall
A&S
Friday Exploratory 1
Friday Exploratory 2
Assignments due (To be completed by student):
Please make sure ALL your child’s teachers and the Principal sign this form. The signed form should be

eturned to the Front Office BEFORE you leave.
Student’s Signature ____________________________________________
Principal’s Signature ____________________________________________
Parents — Please read and sign the back of this document

Student Absences and Excuses
From BVSD Board Policy JED-R:
All absences have a negative effect on instructional continuity, regardless of the cause of the
absence or the attempts to make up work missed. The school cannot teach pupils who are not
present and the classroom experience can never be duplicated with assignments outside of school.
Regular interactions of pupils with one another in the classroom and their participation in a
well-planned instructional activity under the tutelage of a competent teacher are fundamental
requirements of a sound educational program.
Excused Absences
The Principal has the authority to determine whether an absence is excused or unexcused. Excused
absences include the following:
1. Temporary illness or injury.
2. An absence which is approved by the Principal.
3. Extended absences due to physical, mental, or emotional disabilities.
4. An absence which occurs when the student is in the custody of a court or law enforcement
authorities.
5. Emergency, serious illness, or death in the family.
6. Medical and dental appointments which cannot be scheduled outside the regular school day.
7. Extremely inclement weather.
8. Absence directly related to the primary handicapping condition of an identified disabled
student.
9. Participation in religious observances.
10. An absence resulting from participation in a work-study program under the supervision of a
public school.
Pre-Arranged Absences
The Principal may excuse absences on a pre-arranged basis in the following circumstances:
1. Special family activities.
2. Extenuating circumstances determined by the principal.
Such absences that are not pre-arranged will not be excused. Pre-arranged absences may
necessitate a parent conference.
By signing this document, you acknowledge district policy on pre-arranged and excused absences:
__________________________________________
Parent Signature
_________________________________________
(print name)

Date: __________________