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.

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.