Leave of Absence Request

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

Name of Child(ren)

First Name

Last Name

Class

Date of birth

YYYY

Date of First Day of Absence

YYYY

Date of Return

YYYY

Number of Days/Hours Requested

Please note the appointment time if not a full day absence

Known siblings and school(s) attending

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

Name of Parent completing form

First Name

Last Name

Date completed

YYYY