Leave of Absence Request
Please complete one leave of absence request per child (do not group siblings together)

Thank you 

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Child's Name *
Child's Date of Birth *
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Year Group:  *
Address *
Contact Number *
I request permission for my child to be absent from school

First Day of Absence:
 *
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Date of Return *
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Total School Days *
Please let us know your destination of travel *
Please fully explain the exceptional circumstances that you would like the Head teacher to consider:
 *

Declaration

I have read and understood the information about leave of absence during term time, unauthorised absence, and Penalty Notices (available on our website) I am aware of the possible consequences should my child take a leave of absence without the prior authorisation of the Head teacher.

 *
Parent/Carer Name(s)  *
Date of request *
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