Leave of Absence Request Form

Please complete the form below to request a leave of absence for your child.

Name of child/children *

Year Group

Date of Birth *

Start date of proposed absence *

End date of proposed absence *

Number of school days missed *

Reason for absence *

I have completed the above form fully, accurately and in detail. *

I understand that the decision on whether my child can be granted absence from school during term time rests solely with the school, and that I cannot appeal the decision made. *

I understand that if my request is rejected and I choose to remove my child from school in contradiction to the school's decision, I may face a fine of up to £120 per parent per child. *

Name of Parent *

Email *

Date of request *

Separate email addresses with a comma.

Submit