Child Appointment/Other Leave of Absence Form

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Please complete this form if your child has a medical appointment or you are requesting leave of absence for an emergency or planned holiday. This form should be used in accordance with Appendix 3, attached to the Governors Policy 'Pupils leave of Absence during term time,' on our school website. You will find this under the School Information tab, School Attendance and by clicking the read more section.

Email *

Child's Full Name *

What class is your child in? *

Tiny T's

Mini T's

Reception W

Reception G/M

Year 1 LH

Year 1KH

Year 2CM

Year 2LM

Year 3E/W

Year 3M

Year 4D

Year 4P

Year 5C

Year 5G

Year 6W

Year 6F

We are requesting leave of absence for: Please give as much details as possible e.g. date/time/reason and the time if you need to collect your child during school hours. *

Hospital

Dental

Optician

Family Holiday - Please Note holidays during term time will not be authorised

Other - Please state reason below for absence and include date / time of collection

Details

Date and time of appointment / absence *

I will collect my child from school at the following time: *

A copy of your responses will be emailed to the address you provided.

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