Holiday/Absence Application

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Name of Child *

Class *

First day of absence from school
*

YYYY

Date of return to school
*

YYYY

Total number of school days
*

From 1st September 2013, the reference in law to Headteachers/Principals being able (at their discretion)
to agree up to 10 days of leave of absence has been removed. Instead, the legal reference has been
amended and will mean that schools cannot authorise leave of absence unless:

The Head teacher/Principal considers that there are exceptional circumstances relating to the application.

PLEASE DO NOT BOOK ANY FLIGHTS/HOTELS/ETC UNTIL LEAVE HAS BEEN AGREED.

I request absence for my above named child to accompany me on a visit to
*

The reason for this visit is

(Please note that the Headteacher is unable to consider your visit request unless you give a reason.)

I will arrange for the following friend/relative to notify the school if there are any changes to my travel
arrangements, which may affect my date of return and understand that you may contact that person in the
event of my child not returning to school on the agreed date.

Name of parent/relative
*

Telephone
*

Email *

Signed (Parent/Carer with Parental responsibility)
*

Date
*

YYYY

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