Application for Approved Leave from Orange Anglican Grammar School

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Please complete this form in full to apply for exemption. Completion of the exemption does NOT guarantee approval. You will be informed via email of the outcome of your application.

Student's First Name *

Student's Family Name

Student's date of birth *

YYYY

Student's Year group *

Prep

Kindergarten

Year 1

Year 2

Year 3

Year 4

Year 5

Year 6

Year 7

Year 8

Year 9

Year 10

Year 11

Year 12

Other:

Required

Student's residential address *

First day of leave from school applied for *

YYYY

Last day of leave from school applied for *

YYYY

Total number of school days that the student will be away from school for *

Please choose the option that best describes the grounds for your request for approved leave or exemption for the student *

Family Holiday/ Overseas Travel

Exceptional Circumstances

Representing OAGS in Sport or Equestrian

Sporting event outside of OAGS including dance and local/state teams

Elite sporting event representing Australia

Employment in entertainment industry

Other:

Required

Please provide any further relevant information about the circumstances of the requested leave:

Full name of the parent/carer completing this application *

If the parent/carer lives at a separate address to the student for which this exemption is relevant to, please enter your address below

Telephone number of parent carer completing this application *

As the parent/carer for the student listed above, I hereby apply for a certificate of exemption from attendance at School, under the Education Act 1990. I understand that if the leave/exception is granted: *

I am responsible for his/her supervision

The exemption is limited to the period indicated

The exemption may be cancelled by the school if deemed necessary

Required

I declare that the information provided in this application is to the best of my knowledge and believe accurate and complete. I recognise that should statements in this application later prove to be false or misleading , any decision made as a result of this application may be reversed. I further recognise that a failure to comply with any conditions set out in the exemption may result in the exemption being revoked. *

I agree

Required

Date of application *

YYYY

Please enter your email below. Upon submitting this application this email will be recorded and will act as your signature. *

Submit

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