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Application for Approved Leave from Orange Anglican Grammar School
Please complete this form in full to apply for exemption. Completion of the exemption does NOT guarantee approval. You will be informed via email of the outcome of your application.
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* Indicates required question
Student's First Name
*
Your answer
Student's Family Name
Your answer
Student's date of birth
*
MM
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DD
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YYYY
Student's Year group
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Prep
Kindergarten
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Other:
Required
Student's residential address
*
Your answer
First day of leave from school applied for
*
MM
/
DD
/
YYYY
Last day of leave from school applied for
*
MM
/
DD
/
YYYY
Total number of school days that the student will be away from school for
*
Your answer
Please choose the option that best describes the grounds for your request for approved leave or exemption for the student
*
Family Holiday/ Overseas Travel
Exceptional Circumstances
Representing OAGS in Sport or Equestrian
Sporting event outside of OAGS including dance and local/state teams
Elite sporting event representing Australia
Employment in entertainment industry
Other:
Required
Please provide any further relevant information about the circumstances of the requested leave:
Your answer
Full name of the parent/carer completing this application
*
Your answer
If the parent/carer lives at a separate address to the student for which this exemption is relevant to, please enter your address below
Your answer
Telephone number of parent carer completing this application
*
Your answer
As the parent/carer for the student listed above, I hereby apply for a certificate of exemption from attendance at School, under the Education Act 1990. I understand that if the leave/exception is granted:
*
I am responsible for his/her supervision
The exemption is limited to the period indicated
The exemption may be cancelled by the school if deemed necessary
Required
I declare that the information provided in this application is to the best of my knowledge and believe accurate and complete. I recognise that should statements in this application later prove to be false or misleading , any decision made as a result of this application may be reversed. I further recognise that a failure to comply with any conditions set out in the exemption may result in the exemption being revoked.
*
I agree
Required
Date of application
*
MM
/
DD
/
YYYY
Please enter your email below. Upon submitting this application this email will be recorded and will act as your signature.
*
Your answer
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