YOU MAY AVOID AN ABSENSE FOR A MISSED ACTIVITY IF IT IS RESCHEDULED. YOU MUST MAKE THE REQUEST IN WRITING BY:

1. APPEARING AT THIS CENTER AT LEAST 24 HOURS PRIOR

TO THE SCHEDULED ACTIVITY.

2. COMPLETE THIS REQUEST TO RESCHEDULE FORM.

3. HAVE IT APPROVED AT THE TIME YOU ARE HERE BY EITHER

THE PROGRAM DIRECTOR, THE PROGRAM ASSISTANT, OR

A COUNSELOR, AND

4. BEING ASSIGNED A NEW TIME/DATE FOR ACTIVITY YOU ARE

PLANNING TO MISS AT THE EARLIEST AVAILABLE OPENING.

CLIENT NAME___________________________COUNSELOR________

DATE/TIME OF REQUEST____________________________________

ACTIVITY_______________CURRENTLY SCHEDULED FOR__________

REASON FOR REQUEST______________________________________

________________________________________________________

SIGNATURE/TITLE OF STAFF APPROVING

NEW DATE/TIME SCHEDULED_________________________________

________________________________________________________

CLIENT SIGNATURE/DATE