APPLICATION BY PARENT/CARER FOR CHILD’S LEAVE OF

ABSENCE FROM SCHOOL DURING TERM TIME

Pupils Name …………………………………….  Tutor Group/Class

Home Address …………………………….........................................

………………………………………………………………………..

I wish to apply for my child to be absent from school during the following dates:

Date of last day at School ………………… Date of return to school …………..

Total number of days missed ……….

 Reason for absence from school ……………………………………………………

 ……………………………………………………………………………………….

……………………………………………………………………………………….

 I make application for my child named above to have authorised absence from school for the reasons stated.   I understand that if this is not agreed then any absence will be treated as unauthorised and may lead to the issue of a Penalty Notice or a Summons for irregular school attendance.

Name of Parent/Carer making application …………………………………………….

 Signed ………………......................... Date ……………………………………………

 PLEASE RETURN COMPLETED APPLICATION FORM TO YOUR CHILD’S SCHOOL GIVING AT LEAST 4 WEEKS NOTICE OF INTENDED ABSENCE

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