I/We request that my/our child (name)

is withdrawn from learning between (dates)

and

Total number of days' absence requested

By signing this Request to Withdraw my Child from Learning form, I/we understand the following:

1. In accordance with the provisions of the Education (Pupil Registration) (England) (Amendment) Regulations 2013, Headteachers are prohibited from granting any leave of absence unless in exceptional circumstances.
2. Leave of absence is granted entirely at the head teacher's discretion. Where a parent makes an application for leave of absence, the Headteacher must be satisfied that there are exceptional circumstances that warrant the leave being granted.
3. Where leave of absence is granted, the Headteacher will determine the number of days a pupil can be away from school.
4. The regulations do not allow the Headteacher to give retrospective approval. All requests for leave of absence must be received ten school days in advance; late requests for leave of absence may not be authorised.
5. If the Headteacher does not authorise leave of absence for the purpose of a holiday and the parents still take the child out of school, or the child is kept away for longer than was agreed, the absence will be recorded as unauthorised.
6. In accordance with the school's Attendance Policy, should you decide to withdraw your child from learning without having obtained the prior permission of the Headteacher, your child's absence will be recorded as unauthorised and you may be issued with a Penalty Notice (£60 per parent, per child, rising to £120 per parent, per child)