Holiday/Extended Leave Request Form

Holiday/Leave of Absence Request Guidance and P…

Application for Leave of Absence – Penwortham Girls’ High School

Please ensure you have read the attached guidance before requesting a leave of absence.

Please note: There is no entitlement to a leave of absence. A leave of absence will only be granted in exceptional circumstances.

An unauthorised leave of absence could result in each of the pupil’s parents/guardians being issued with a fixed penalty fine.

Name of Student

First Last

Form

I wish to apply for a leave of absence from school:

From

Number of missed school days

Reason for absence

Signature (Parent/Guardian)

Date

Signature (Parent/Guardian)

Date

In the event that the above named child isn’t resident with both parents, signatures from both parents are required.

Address

Address Line 1 Address Line 2 City County Post Code Country

Telephone

Office use:

Authorised: Y / N

Reason:

Date: