Bolivar Music Department

PERFORMANCE / REHEARSAL EXCUSED ABSENCE REQUEST FORM

THIS FORM SHOULD BE SUBMITTED AT LEAST TWO WEEKS PRIOR TO THE SCHEDULED ACTIVITY  

Date                                       

Student’s Name                                                                                 Grade                        

Instrument or Position                                                                                                           

I am requesting permission for my son/daughter to be excused from the activity listed below according

to the policies outlined in the band/vocal handbook regarding excused absences.

                                                                                                       on                                           

  INDICATE THE SPECIFIC PERFORMANCE EVENT OR REHEARSAL HERE                  DATE OF THE EVENT

Briefly state the reason you are requesting your student be excused from this commitment below.

 Parent’s Signature                                                                           Phone #                                   

REQUEST FOR EXCUSED ABSENCE GRANTED BY ____________________________________ ON                              

THIS FORM WILL BE KEPT ON FILE FOR REFERENCE DURING THE GRADING PERIOD

BAND MEMBERS SHOULD RETURN THIS FORM TO MR. MCCLARD OR MR. KNUPPS