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Family Travel Acknowledgement Form

Parents/Guardians who plan to take their children on an educational family trip should submit this Family Travel Acknowledgement Form to the school principal. This form should be submitted two weeks prior to the trip to allow for proper notification. After the form has been reviewed and processed, the principal will send a copy of this form to you indicating an acknowledgement of the planned absence.

As per Wissahickon School District Board Policy #204, there is a five-day limit to non-school sponsored travel per school year. A maximum of fifteen days of cumulative lawful absences verified by a parent/guardian note may be permitted during the school year. It is important to keep in mind that Family Travel absences are included in the fifteen days of cumulative lawful absences. This form acknowledges the allowable five days of Family Travel as long as the student does not have fifteen days of lawful absences already accumulated or will not have ten days of lawful absence by the date(s) of travel.

Please Note: Nonschool sponsored travel will not be approved as an excused absence during standardized testing dates. Students are responsible for missed work during their absence. Thank you for your cooperation.

Student Name(s): ____________________________ Grade/Teacher: ______________

Dates of Absence: From _____________ Through _____________ # of Days Absent = ______

Trip Destination: ______________________________________________________________

Signature of Parent/Guardian: _________________________________ ___/___/____

IMPORTANT – Individuals who travel internationally should follow guidance on the Center for Disease Control (CDC) website regarding international travel.


A copy of this form will be sent to the parent/guardian(s) once it has been reviewed.

Signature of Principal: _________________________________ ___/___/____

Acknowledgement of Travel Dates

☐ This form acknowledges the allowable five days of Family Travel.

☐ This form acknowledges the allowable five days of Family Travel, but the balance of ___ days cannot be approved as they exceed the allowable five-day number of Family Travel days. These additional absences will be coded as unexcused absences.

☐ Your child has already accumulated 15 days of absence this school year; as a result, the Family Travel Days noted in this form cannot be approved. In the event that your child is absent on these days, they will be coded as unexcused absences.

☐ Other:


FOR OFFICE USE ONLY

# Days Absent This School Year: ______ # Days Late Arrival This School Year: ______