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Request for Exceptional Leave 2022-2023
This form is for all absences from learning other than sickness.
Please complete a separate form for each child and each absence.
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* Indicates required question
Name of child:
*
Your answer
Current Class
*
Robins
Wren
Jay
Woodpecker
Owl
Puffin
Kingfisher
Swan
Hawke
Osprey
Falcon
Name of personal completing the form
*
Your answer
Relationship with the child
*
Mother
Father
Carer
Grandparent
Other:
Dates requested for leave from
MM
/
DD
/
YYYY
Dates requested for leave to
MM
/
DD
/
YYYY
Number of days absent from school
Your answer
Please tick which of the following exceptional circumstances applies:
Unavoidable medical/dental appointments (evidence required)
Days of religious observance
Seeing a parent who is on leave from the armed forces (evidence required)
Holidays planned during pre-post deployment leave for the armed forces (evidence required)
External examinations (evidence required)
Where it is company/organisational policy for a parent to take leave at specified time and no opportunity in school holidays (evidence will be required)
Where holiday is recommended as part of a parent or child's rehabilitation from medical or emotional issue (evidence required)
Other:
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