St Monica's Primary School - Term Time Leave of Absence Form 
  • This form is to be complete by the parent with day to day care of the pupil requesting an absence. 
  • Schools by law have to account for all pupil absences; therefore all applications for leave during term time have to be formally reviewed and approved by school. 
  • If the absence is is not approved, but taken, it will be recorded as unauthorised. 
  • The Education Welfare Service has a legal obligation to monitor all absences and take action where necessary. 
Once you have completed the form below, please EMAIL the school office to advise this has been completed & your absence request will then be reviewed. 
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Child's Name
Year Group 
Date of Application: 
MM
/
DD
/
YYYY
Date of Proposed Absence: From 
MM
/
DD
/
YYYY
Date of Proposed Absence: To (Inclusive)
MM
/
DD
/
YYYY
Circumstance Requiring Application for Authorised Leave of Absence - (Additional Supporting Evidence may be provided if you wish). 
Parent Name 
The Next Section of the Form is for Office Use Only 
Absence Authorised 
Clear selection
Signed: (Head Teacher) 
Date
MM
/
DD
/
YYYY
Noted & Signed By Education Welfare Officer 
Submit
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