Exceptional Leave Of Absence request form
Please be aware, as per our school’s attendance policy and the Hertfordshire published Code of Conduct relating to school attendance, that the law requires parents to seek permission from the head teacher to take their child out of school during term time. The law states permission can only be granted if: 1. An application has been made in advance by the parent the child normally lives with; and 2. There are exceptional circumstances. Please also note that, if on the rare occasion circumstances are deemed exceptional by the head teacher, the duration your child is permitted to be away from school may only be determined by the head teacher.
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Email *
Pupil's full name: *
Pupil's Date of Birth *
Year Group *
Class name *
Pupil's full address and postcode *
First date of absence  *
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Last date of absence *
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Date of return to school *
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Number of school days absent *
Please detail below the reason for your request for absence from school in term time and why you believe this to be exceptional. If you have supporting evidence please email this over to admin. *
If you have a child/ren at another school/s, please detail their name/s and which school/s they attend below
Full name of person making this request *
Relationship to child *
Full address and postcode if different from child's above
Parent’s Declaration:
I have read the schools attendance policy and understand I/we may receive a penalty
notice if my/our child receives unauthorised school absence as a result of this request.
Should the number of unauthorised absence sessions reach 10 sessions within a rolling period of 10 school weeks you will be in breach of the regulations and the Local Authority may issue you with a Penalty
Notice.
The notice requires you to pay a penalty of £80 within 21 days, rising to £160 if paid after 21 days but
within 28 days. Each parent is liable to pay a separate penalty and penalty notices issued for each child
to whom the absence relates.
Payment of the penalty enables you to discharge your liability for the offence for the period in question
of failing to ensure your child’s regular attendance at school. (section 444, The Education Act 1996).
Failure to pay the penalty means you are liable to prosecution for the offence, by summons to appear
before the local Magistrates Court. This is a criminal offence which carries a criminal record.

Please sign and date:
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A copy of your responses will be emailed to the address you provided.
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This form was created inside of Highover JMI School & Nursery.