* Required

Lakeshore Middle - Student Absence Form

Student's First Name*required

Student's Last Name*required

Student's Teacher

Was the student absent for multiple days?*

Yes No

Date Absent*required (mm/dd/yyyy)

Last Day Absent*required (mm/dd/yyyy)

Reason for Absence*required

If the student has a doctor's note please attach below or provide to office staff.

Doctor's Note

Max file size: 10 MB

Your First Name*required

Your Last Name*required

Relationship to Student*required

Your Email

Your Phone Number