( 1) Certification shall be sufficient if it states in writing:

1. (a) the date on which the leave will be taken;
2. (b) the duration of the leave;
3. (c) the purpose for requesting the leave; (d)· the employee's signature.

1. (2) The following certification form may be used by employers:

   Employee's Certification

I certify that on - - - - - - - I will/did take _ __ hours of leave for the following purpose:

D to participate in school activities directly related to the educational advancement of a son or daughter

D to accompany the son or daughter of the employee to routine medical or dental appointments such as check ups or vaccinations

D to accompany an elderly relative to routine medical or dental appointments or appointments for other professional services related to the elder' s care

Employee's Signature: _ __ ______ _ Date: _________ _