SAI - Leave of absence form (term time)
You must make this application to the Headteacher before you take your child out of school - you cannot complete on your return.
By completing this form, I understand that:
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I must make this application to the Headteacher before I take my child out of school - it cannot be completed afterwards or when they return.
I must be the parent/carer with whom the child normally lives.
I must submit a separate form for EACH child that attends St Anne's Infants School & Nursery
The Headteacher will consider whether there are exceptional circumstances in relation to the application. See the school attendance policy - for further information.
If the leave of absence is granted, it is up to the Headteacher how many days will be authorised.
Child's details
Child's name
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First Name
Last Name
Child's date of birth
*
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Day
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Month
Year
Date
Year group
*
Please Select
Nursery
Reception
Year 1
Year 2
Please provide details about why you believe this absence is exceptional:
*
Absence details
*
Address where we will be staying:
*
I understand that:
*
If the leave is not agreed or I / we do not return at the agreed time; I / we may be issued with a penalty notice per parent, per child. If I / we do not pay the fine, the case may be referred to Court which could result in a criminal record and fines up to £2500 and/or 3 months imprisonment.
If travelling abroad, I / we will supply a copy of the return travel documentation and the name & phone number/email of a contact person whilst abroad.
I / we are aware that if we do not return at the agreed time, Children Missing Education enquiries might be made, and further investigations may take place regarding the child’s whereabouts. In exceptional circumstances this could result in the child being removed from the school roll.
In exceptional circumstances, penalty notices may not be issued, and cases may be taken straight to Court.
If the leave of absence is agreed, it will be coded as an authorised absence for the agreed period.
Where leave in term time has not been agreed or for the days taken in excess of an agreement, it will be coded as unauthorised absence.
Parent's Name
*
Parent's Signature
*
Parent's Email
*
example@example.com
Today's Date
*
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Day
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Month
Year
Date
Continue
Continue
Should be Empty: