I would like to apply for "Leave of Absence" from school for the above named children.

The Headteacher may only grant "Leave of Absence" in exceptional circumstances. Please give the reason that leave is required in the box below.

By digitally signing this form, I understand the following:

1. The School's Attendance policy states that absences during term time will not be authorised unless the Headteacher agrees that there are exceptional circumstances and that any absences will be recorded as unauthorised on the school register.

2. Any unauthorised absences may be referred to the Education Investigation Service.

3. I understand that if a referral is made to The Education Investigation Service, I may be subject to a Penalty Notice (a fine of up to £120 in respect of each child and each parent) and/or be subject to further legal proceedings in the Magistrates Court.

4. If my child does not return to school after the above leave of absence date, school may remove my child's name from the school register under Regulation 8, 1 (f) of The Education (Pupil Registration) (England) Regulations 2006.

By typing your name in the next box, this constitutes a digital version of your signature. This is in place of your physical signature on a paper form.