Application for Leave of Absence Form
Please read the following guidance carefully.

As parents, you have a legal responsibility to ensure your child's attendance  at school. During the academic year, pupils are at school for 190 days and at home for 175 days.
Please be aware that The Education (Pupil Registration)(England)(Amendment) Regulations 2013, which becomes law on 1st September 2013 state that Headteachers may not grant any leave of absence during term time unless there are exceptional circumstances. The Headteacher is also required to determine the number of school days a child can away from school if leave is granted.

Please complete and submit this form if you want he Headteacher to consider your request for your child's leave of absence for exceptional circumstances. We may ask for proof to back you your request.

Unauthorised absence of 5 days or more may result in the issue of a Penalty Notice.
Penalty Notices are issued by the Local Authority in accordance with Surrey County council's Code of conduct. The Penalty Notice is £60, per child per parent/carer, if paid within 21 days or £120 if paid after 21 days but within 28 days. Failure to pay the Penalty Notice will result in you being served a summons to appear at the Magistrates Court.

The Headteacher will consider the reason for the request carefully and will  notify you of the decision. For further information, please refer to our School Attendance Policy.

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Confirm you have read the above statement *
Please Note you will have to email evidence of the request, such as hospital/medical appointments, holiday details. Email: info@sendcofe.co.uk *
Date of absence: *
MM
/
DD
/
YYYY
Name of Pupil *
Class name: *
Return Date of Absence *
MM
/
DD
/
YYYY
Time of Absence: *
Time
:
Return Time of Absence: *
Time
:
Contact email address: *
Contact number: *
Reason for absence: *
Please provide further details of absence *
Completed by School Office: number of absences
Completed by School Office: evidence seen?
Clear selection
Completed by School Office: Approved by Headteacher
Clear selection
Completed by School Office: reason for non-approval
Submit
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