Absence Request Form

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This form should be completed and submitted to Ms L Loynes (Headteacher) within four weeks (if possible) of the start of the proposed absence.

Parents and carers are reminded that absence taken without authorisation may result in the issuing of fixed penalty fines by the Local Authority of up to £120 per parent, per child.

Parents and carers are also reminded that absence for the purpose of holidays during term time can no longer be granted and that absences can only be authorised in the most exceptional circumstances.

Email *

Name of child. *

Please give your child's class and year group. *

Your name and relationship to child. *

Your mobile telephone number and email address *

What is the start date of the proposed absence? *

YYYY

What is the end date of the proposed absence? *

YYYY

How many days will your child be absent from school? *

What date is your child due back in school? *

YYYY

What is the reason for your request? *

DISCLAIMER: By typing your name below, you are signing this document electronically. You agree that your electronic signature is the legal equivalent of your manual/handwritten signature.

Name of Parent / Guardian:

A copy of your responses will be emailed to the address you provided.

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