Leave of Absence Request

LEAVE OF ABSENCE REQUEST FORM

Please complete the section below, giving full details of your reason for requesting a leave of absence.

The headteacher may invite you to attend a short meeting to discuss your leave of absence request.

Please do not book your holiday until you receive confirmation that your request has met the criteria for approval.

Please Note : If a parent/carer takes an unauthorised leave of absence a penalty notice may be issued. When a penalty notice is issued, it will be issued per parent per child.

Repeat unauthorised absence may result in the LA moving directly to prosecution.

Name of school

Pupil name

Class

Parent / Carer 1 Name

Parent/Carer 1 Address

Parent/Carer 1 Date of Birth

Parent / Carer 2 Name

Parent/Carer 2 Address

Parent/Carer 2 Date of Birth

Date from

Date to

Total school days

Reason for absence request

Date of request

If you are human, leave this field blank.

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Leave of Absence Request