Leave Of Absence Request Form - St George'S C Of E Primary School printable pdf download

St. George’s C of E Primary School

Pound Lane, Semington

Wiltshire, BA14 6LP

Tel: 01380 870243

admin@st-georges-semington.wilts.sch.uk

Head teacher: Mrs Helen Biles-Wood

I can do all things through Christ who strengthens me.

Leave of Absence Request Form

Taking your child out of school during term time may harm your child’s academic progress.

As agreed with the Melksham Area Headteacher Cluster and in accordance with Wiltshire Council

guidelines, Leave of Absence taken during term time will be Unauthorised. However, schools may agree

up to 10 days Leave of Absence in special circumstances with consideration being given to pupil’s

attendance, attainment and public examinations. In these circumstances absences may only be

authorised at the discretion of the Headteacher.

Please read the attached Local Authority leaflet

which explains Penalty Notices issued for unauthorised

Leave of Absence during term time. Please note that school is required to send Wiltshire Council notice

of unauthorised absence if a pupil has 10 half day sessions (5 days) of unauthorised absence, due to

holidays, within a six month period of a school year. It is then the decision of Wiltshire Council as to

whether to issue a Fixed Penalty Notice or not.

Name of Child(ren)

Date of Birth

Class

Date of First Day of Absence

Date of Return to school

Number of Days requested

Known siblings and schools

attending

Reason for Leave of Absence to be taken during term time:

………………………………………………………………………………………………………………

Signed: __________________________

Date: ____________

Request authorised: YES

For school use only:

Attendance%:

Total sessions pupil absent this academic year:

Total unauthorised absence this year:

Signed by Headteacher _______________________________ Date _______________

Leave Of Absence Request Form - St George'S C Of E Primary School