RELIGIOUS HOLIDAY(S) EXEMPTION REQUEST

(These will be counted as excused absences!)

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Student’s Name Grade School

I am requesting that my son/daughter be excused for observance of the following religious holidays. He/She will be participating in religious activities on the date(s) indicated/checked below as verified by my signature.

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Parent’s/Guardian’s Signature Date

Work Phone: _________________________ Home Phone: _______________________

Holiday Observance Religious Group Date(s)

Rosh Hashanah Jewish ___________________________

Yom Kippur Jewish ___________________________

Sukkot Jewish ___________________________

Shemini Atzeret Jewish ___________________________

Simchat Torah Jewish ___________________________

Diwali Hindu ___________________________

Guru Nanak’s Birthday Sikh ___________________________

Id-al-Fitre Muslim ___________________________

Id al-Adha Muslim ___________________________

Holi Hindu ___________________________

Pesach Jewish ___________________________

Wesak Buddhist ___________________________

Good Friday Christian ___________________________

Holy Friday Christian ___________________________

Shavuot Jewish ___________________________

Other:

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Distribution – White: Parent Canary: School Pink: Intervention Services

Equal Opportunity Employer – (850) 487-7105