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Leave of Absence Request Form

Taking your child out of school during term time may harm your child’s academic progress. 

Absences may only be authorised at the discretion of the Headteacher in EXCEPTIONAL circumstances.

Circumstances which are notified to the school or Local Authority after a decision has been made by the Headteacher will not be considered. Therefore please be certain to provide details of the exceptional circumstances relating to your application below and attach any supporting evidence.

Please read the attached Local Authority leaflet which explains Penalty Notices issued for unauthorised Leave of Absence during term time.

Name of Child(ren)

 

 

Date of Birth

 

Class

 

Date of First Day of Absence

 

Date of Return

 

Number of Days requested

 

Known siblings and school(s) attending

 

 

 

 

Exceptional Circumstances (reason) for Leave of Absence during term time: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………......................

Signed:          __________________________                     Date: ____________

 

Parent/Carer: ___________________________

 

For school use:

Attendance%

Total sessions pupil absent this academic year:

Total unauthorised absence this year:

Request authorised:   Yes/No