Child's Name
Date of Birth
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Class
Name of Parent/Guardian
Reason for Absence
Why are these exceptional circumstances/Why should the Headteacher authorise this absence? (Please refer to our Attendance policy for guidance on exceptional circumstances)
Number of school days absent
Destination
First date of absence
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date due back in school
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent's/Guardian's Signature
Date form completed
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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