Leave of Absence Request
Parents and Carers are reminded that leave of absence taken without permission may result in the issuing of a fixed penalty by the local authority of up to £120 per parent per child.
If your child is going to be absent for any reason this form should be completed and submitted FOUR WEEKS prior to the start of the proposed leave of absence.
Parents are also reminded that leave of absence for the purpose of holidays in term time can no longer be granted save in the most exceptional circumstances.
Please read the term time holidays section on our website for further information.
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Name of child *
Class *
Name of Parent/Carer *
Address *
Telephone number *
First date of absence *
MM
/
DD
/
YYYY
Last date of absence *
MM
/
DD
/
YYYY
Total number of school days requested *
Reason for request,  please include any exceptional circumstances. *
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