Brunswick High School Band Department

EXCUSED ABSENCE REQUEST FORM

To be completed 1 month prior to a performance conflict, 2 weeks before a rehearsal conflict or 48 hours after an emergency absence.

Student Name requests an excuse for (circle one)

Absence Tardy Early dismissal

from a on .

(rehearsal or performance) (date)

Specific Reason for Absence

(Work is not an excused absence.)

Student Signature

Parent Signature

ü Please complete a copy of this form and return to the Band Secretary.

ü Student will receive a copy of this form if the Excuse is classified as UNEXCUSED.

DATE RECEIVED

EXCUSED UNEXCUSED

Director Comments

Director Signature Date

Mr. Wardeska