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
Date
Last date of absence*

DayMonthYear
Date
Date of return to school*

DayMonthYear
Date
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.