I couldn't give this to my own children until they were old enough to stay home alone safely because I was working full time as a teacher. I could give it to my current kiddos at an earlier age since I am no longer teaching. They each get to pick one day a year when they may choose to stay home without penalty from me. It cannot be on a day they have a test, nor the first day of school. They can only use this pass one time per year.
I find this token is rarely used. I remind them of it whenever they try to play sick and clearly are not. It seems to eliminate some of the usual hassles/whines about "I don't want to go to school today." It avoids most of the rants and rages and fights by putting a bit of choice/power in their hands. I simply ask if they are using their Skip Pass that day and remind them that they only have one. Usually the child decides s/he might need it more later and goes ahead to school. If they choose to use it, fine. Sometimes they choose to use it on their birthday, as my kiddo is tomorrow. I call the school to let them know that s/he will not be in school that day. They may spend the day as they choose as long as it is acceptable behavior that doesn't break family rules and doesn't interfere with my duties for the day.
My kids like the idea, teachers live with it [once I explain it is only one day], and I find it acknowledges the wishful thinking we all have about working, helps the children be honest, to make conscious choices and it helps promotes good decision making. Besides... it is one of the rare things I do that they think is cool. :-)
Image credits: ventingstation.com, westsoundacademy.org