Term-time Leave Request Form

I have read and understand the information provided on the Holidays & Leave page

Your Name *

Your Email *

Select type of leave request *
—Please choose an option—MedicalHoliday requestSport/Theatre/Dance CompetitionOther Leave request

Reason for request ('Holiday' is not sufficient) *

First date of absence * (YYYY-MM-DD)

Last date of absence * (YYYY-MM-DD)

Total school days requested absent *

Pupil 1: Name and Year Group *

Pupil 1: Last attendance report percentage *

Pupil 2: Name and Year Group

Pupil 2: Last attendance report percentage

Pupil 3: Name and Year Group

Pupil 3: Last attendance report percentage

Pupil 4: Name and Year Group

Pupil 4: Last attendance report percentage

OFFICE USE: Attendance levels

Headteacher authorisation?

Educational Social Worker informed?

Teacher notification

Parent notification

I understand and accept that by submitting this information I am authorising the school to store the data provided in a digital or paper format indefinitely or until I request its deletion.