Leave of absence request

Application for Leave of Absence from School during term time.

(Please ensure a separate form is filled out per child)
Dear Headteacher,

I would like to request permission for leave of absence for my child, a pupil registered at your school for the reasons detailed below.
Pupil name

First NameLast Name
Pupil date of birth
Year Group
Class
Address

Street Address

Street Address Line 2

CityCounty

Postcode
First date of absence

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Last date of absence

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Date of return to school

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Total number of school days absent
Reason for request including why you believe your circumstances to be exceptional.
Full name of person making request (requests must be made by a parent who the pupil normally lives with)

First NameLast Name
Relationship to pupil
Please upload any further documents you feel are relevant.

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Application for Leave of Absence from School during term time.