Request for Exceptional Leave of Absence

Updated September 2017

Please read the following guidance carefully

Please be aware that The Education (Pupil Registration)(England)(Amendment) Regulations 2013, state that Headteachers may not grant any leave of absence during term time unless there are exceptional circumstances. The Headteacher is also required to determine the number of school days a child can be away from school if leave is granted.

As parents, you have a legal responsibility to ensure your child’s attendance at school. During the academic year, pupils are at school for 190 days and at home for 175 days.

Please complete and submit this form if you wish for the Headteacher to consider your request for your child’s leave of absence for exceptional circumstances. We may ask for proof to validate your request. The Headteacher will consider the reasons for the request carefully and will notify you of the decision. For further information, please refer to our School Attendance Policy.

Unauthorised absence of 5 days or more may result in the issue of a Penalty Notice
Penalty Notices are issued by the Local Authority in accordance with Surrey County Council’s Code of Conduct. The Penalty Notice is £60, per child per parent/carer, if paid within 21 days or £120 if paid after 21 days but within 28 days. Failure to pay the Penalty Notice will result in the Local Authority considering legal proceedings against you in the Magistrates Court.

Child/ren Name:* Child/ren Class:* If the absence is for MORE than 1 day please enter the address of the parent applying for leave of absence: First day of absence (dd/mm/yyyy):* Last day of absence (dd/mm/yyyy):* If the absence is for LESS than one day, please enter the time of the absence below: Please give reasons for your decision to take your child out of school during term time, identifying particularly why this time cannot be taken during school holidays (500 characters):*

If your child usually has a school dinner please confirm if they still require one on the date of the planned absence:YesNo

If your child requires a school dinner on the date of the planned absence, please confirm their meal choice below:Main mealVegetarian mealDeliJacket potato/Pasta

Please attach any documentation supporting your request here (e.g. flight/hotel booking, wedding invitation, appointment letter): No file chosen In lieu of signing a paper copy of this form I hereby confirm all information provided on this form is accurate (please type your full name as parent or carer):* Please enter your email address to receive a copy of your submitted form:*

Request for Exceptional Leave of Absence

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