Rutherford Elementary School Note

Central Dauphin East High School Central Dauphin East High School Date:______Grade:______Date:______Grade:______Students Name:______Students Name:______Parent’s Signature: ______Parent’s Signature: ______Check all that apply and complete information. Check all that apply and complete information. ____Student is late because______Student is late because______Student will be picked up at______am/pm by ___Student will be picked up at______am/pm by ______to go to: ______to go to: ___Student will be driving themselves: ___Student will be driving themselves: __doctor appointment __dentist appointment __doctor appointment __dentist appointment __Other (please specify):______Other (please specify):______Student was absent on (date)______because______Student was absent on (date)______because______Other(if needed use back of note)______Other(if needed use back of note) ______

Central Dauphin East High School Central Dauphin East High School

Date:______Grade:______Date:______Grade:______Students Name:______Students Name:______Parent’s Signature: ______Parent’s Signature: ______Check all that apply and complete information. Check all that apply and complete information. ____Student is late because______Student is late because______Student will be picked up at______am/pm by ___Student will be picked up at______am/pm by ______to go to: ______to go to: ___Student will be driving themselves: ___Student will be driving themselves: __doctor appointment __dentist appointment __doctor appointment __dentist appointment __Other (please specify):______Other (please specify):______Student was absent on (date)______because______Student was absent on (date)______because______Other(if needed use back of note)______Other(if needed use back of note)______