REQUEST FOR LEAVE OF ABSENCE Child’s Name: Date (s):

Class: 1st day of absence: Last day of absence:

Total No. Days:

I request a leave of absence for my child to be absent from school for the above date(s) for the reason detailed below: (Please outline the reasons why this absence cannot be taken outside term time)

Please tick here if you also have a child at Eastwick Junior School. Signature of Parent/guardian:

Date:

This form is to be completed by the Parent/Guardian and forwarded to the Head Teacher at least two weeks prior to the above dates. Under regulation 12 of the Education (Schools and Further Education) Regulations 1981, there is a discretionary power for leave to be granted for the purpose of an annual family holiday during term time. Such permission is granted in accordance with arrangements made by the governing Body of the school. Only in exceptional circumstances may the amount of leave granted exceed (in total) more than two weeks in any year. No parents can demand leave of absence for the purpose of a holiday as a right.

To the parents/Guardians of:

Class:

YES – Permission is granted for the leave of absence you have requested for your child. Or NO - Permission is not granted for the leave of absence you have requested for your child, for the following reason:

Signed:

Date: Head teacher