Application for Leave During Term Time

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Parents/Carers must ask permission for their child to be absent during term time, and it is at the Headteacher’s discretion to decide whether or not the absence will be authorised. The Headteacher may authorise leave during term time for exceptional circumstances only. If leave is taken without permission, or no application is made, parents/carers risk being issued with an Education Penalty Notice.

Parents/Carers wishing to apply for their child to have leave of absence from school should complete this form for authorisation at least two weeks before the proposed leave.

Child's name *

Date of Birth *

YYYY

Class *

Full name of Parent (1) *

Address of Parent (1) *

Telephone Number (Parent 1) *

Full name of Parent (2)

Address of Parent (2) *

Telephone no of (Parent 2) *

Do you consider this request to be due to exceptional circumstances? If so, please outline the reasons why. *

Please email your supporting evidence to the school office at schooloffice@sacredheart.wirral.sch.uk

First Day of Absence *

YYYY

Date of Return to School *

YYYY

Departure Date

YYYY

Return Date

YYYY

Would your child miss any national tests or examinations? *

Yes

Has your child had leave during term-time in the last 12 months. *

Yes

If your child has had leave during term-time in the last 12 months please give dates, reasons and numbers of school days leave.

Are there any other siblings? If yes please state their name and the school the attend.

Date Form Completed *

YYYY

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