Request For Exceptional Circumstances Absence In Term Time (Page 2 of 2) in pdf

APPLICATION BY PARENT/CARER FOR CHILD’S LEAVE OF ABSENCE FROM SCHOOL

DURING TERM TIME

If you consider you have to take a holiday in term time, and that you have exceptional circumstances,

please complete this form and return to the school at least 14 days before the date you wish to remove

your child from school.

Student Name ............................................................................. Mentor Group ..............

Home Address ........................................................................................................................

First day of absence .................................... Date of return to school ...................................

Total number of days missed ..................................

Reasons for absence .............................................................................................................

................................................................................................................................................

.................................................................................................................................................

I understand that if the absence request is unauthorised the Behaviour & Attendance Service will be

notified of the holiday taken and a Penalty Notice will be issued. I understand that a Penalty is

issued to each parent for each child taken out of school and that this is a fine of £60 which

increases to £120 if not paid within the first 21 days. I understand that I do not pay this may result

in legal action.

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

Signed ................................................................ Dated ....................................................

(Please ensure you are giving at least 14 day’s notice of the proposed absence)

-----------------------------------------------------------------------------------------------------------------------

Student Name ………………………….……………

Mentor Group ………………………..

 AUTHORISED:

Your request has been authorised for the following dates:

___ / ___ / ___ to ___ / ___ / ___

 UNAUTHORISED:

Your request has been unauthorised for the following dates:

___ / ___ / ___ to ___ / ___ / ___

It is not considered that the circumstances you describe are exceptional. If you proceed to take the

absence a Penalty Notice/s will be issued.

Signed ............................................................. Principal

Date ___ / ___ / ___

Request For Exceptional Circumstances Absence In Term Time Page 2