Application for Leave during Term Time
Parents/Carers must ask permission for their child to be absent during term time, and it is at the Headteacher’s discretion to decide whether or not the absence will be authorised. The Headteacher may authorise leave during term time for exceptional circumstances only. If leave is taken without permission, or no application is made, parents/carers risk being issued with an Education Penalty Notice.

Parents/Carers wishing to apply for their child to have leave of absence from school should complete this form and return it to school for authorisation at least two weeks before the proposed leave.  
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Surname of child *
First name of child *
Date of Birth *
Year Group
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Registration Group *
Full name of parent (1) *
Address of parent (1) *
Postcode *
Telephone No *
Full name of parent (2)
Address of parent (2)
Telephone No.
Do you consider this request to be due to exceptional circumstances? If so, please outline the reasons why
Date of leave - from and to including number of schools days being requested.
Would your child miss any national tests or examinations? 
Has she/he had leave during term-time in the last 12 months?
If yes to above,  please give dates, reasons, and number of school days leave
Are there any other siblings affected?
If yes to above, please state their name and the
school they attend 
Please type your name below as digital signature to confirm all of the above details are correct *
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