Request for leave of absence in term time

Holtsmere End Infant & Nursery School

Request for leave of absence in term time
Parents, you do not have the right to take your child out of school during term time. By law you must ask permission for your child to miss school. Head teachers may not grant any leave of absence to pupils during term time unless there are 'exceptional circumstances'. Without 'exceptional circumstances' detailed on this form your request will be instantly denied, please include evidence to support your request. If you would like to apply for permission for your child to be absent from school you must complete this form and submit it to school for authorisation at least 20 school days in advance of the proposed leave, without notice the request may be refused. A penalty notice may be requested if you choose to take your child out of School without authorisation.

Please note - Your request will be denied if:

Your child has already had term time leave this year.

Your child's attendance is below 97% (where there is a medical reason for attendance discretion will be used)
Child's name*

First NameLast Name
Child's class
Reason and DESTINATION for the absence in term time:*
Exceptional circumstances, e.g, funeral, wedding of parents/siblings, parent's work commitments. Please provide evidence of exceptional circumstances where appropriate e.g, work letter
Date of absence from:

DayMonthYear
Date
Date of absence to:

DayMonthYear
Date
Number of school days missed:
Would the pupil miss the first two weeks in September?*

YesNo
Would the pupil miss any national tests, eg, Phonics screening check in Year 1 (June)*

YesNo
Would the pupil be absent for more than ten school days?*

YesNo
Has the pupil already had leave during term time this year?*

YesNo
I understand that any leave that is authorised can be changed to unauthorised if my child's absence causes concern
Parent / Carer name*

First NameLast Name
Date*

DayMonthYear
Date
Should be Empty:

Holtsmere End Infant & Nursery School