Banks Lane Infant & Nursery School - Leave of Absence Request Form
This form should be completed and submitted to the Headteacher within four weeks of the start of the proposed leave of absence. Separate forms should be completed for each child if more than one. Parents and carers are reminded that Leave of Absence taken without permission may result in the issuing of Education Penalty Notice fines of £60 (rising to £120) per parent per child by the Local Authority. Parents are also reminded that Leave of Absence for the purpose of holidays in term time can no longer be granted unless in the most exceptional circumstances.
Email address *
Name of Child *
Date of Birth *
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Name of Parent *
Class *
Address *
Telephone Number *
Start date of proposed leave of absence *
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Date back in school *
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Total number of days absent *
Reason for request *
Signature (please type your name here) *
Date *
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Submit
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