Student Application Form for Leave of Absence for Exceptional Circumstances
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Surname of student: *
First name of student: *
Year Group: *
House: *
Reason for request: *
Date from: *
Date to: *
Time out of school to be missed: *
This cannot be taken during the school holidays because: *
Has your child already had leave of absence in this school year? *
If YES, please give dates and details:
If you have children at other schools, please advise the names of the other schools:
Signed(Parent/Carer): *
Address: *
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