Leave of Absence Request Form
Term time absence will not be authorised unless exceptional circumstances are agreed with the Headteacher.
Exceptional circumstances are defined as an unavoidable cause, e.g. one off emergency or religious observance.

For a family holiday, the parent/carer is requested to complete this form at least two weeks before the proposed period of absence, indicating the exceptional circumstances. Please note you may be asked to make an appointment to discuss this with the Headteacher. If invited, the leave of absence will not be authorised unless the meeting is attended.

Penalty Notice - the school will ask local authority to issue penalty notices if leave is not authorised by the Headteacher. Penalty notices may be issued after five days of unauthorised absences or ten missed sessions in fifty school days. Where penalty notices are imposed, the regulations state that a penalty of £120 is to be paid within 28 days, reduced to £60 if paid within 21 days. Penalty notices are issued to each parent for each child.
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Child's name
Child's class
My child will be absent from (first day of absence)
MM
/
DD
/
YYYY
My child will be absent until (last day of absence)
MM
/
DD
/
YYYY
Please indicate your exceptional circumstances.
My name is
My contact email address is
My contact mobile number is
Date of request.
MM
/
DD
/
YYYY
Submit
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