School Leave of Absence Request Form
Please fill out all required details and submit your request for leave.
Staff instructions: open the form through the admin edit link to complete the internal Office Use Only fields. These fields are for staff completion only and should not be filled out from the public form link.
Parent / Carer Details
Surname
*
First name
*
Relationship to child
*
Please Select
Parent
Carer
Guardian
Postcode
*
Telephone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Child Details
Child surname
*
Child first name
*
Date of birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Year group
*
Please Select
Brambles
Pre-School
Reception
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Siblings Applying
Are any siblings also applying?
*
Yes
No
Sibling details
Leave Request Details
Length of absence (school days)
*
Destination
*
Date of departure
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Return date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Exceptional circumstances
*
Declaration and Applicant Sign-off
Declaration
*
I confirm that the information provided is true and correct to the best of my knowledge
I confirm that all relevant information has been included
Applicant Signature
*
Date of Application
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date received
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Attendance percentage
Approval
Yes
No
Number of days requested
Number of previous applications
Headteacher signature
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Request
Submit Request
Should be Empty: