Parkside Primary School

Please note:

We advise that you do not plan for your child to be absent from school without gaining prior agreement from their school first. Headteachers cannot retrospectively authorise absence from school under any circumstance.

Any disagreement between estranged parents should be resolved prior to submitting this request to your child’s school.

[1] Parent: In this Act, unless the context otherwise requires, “parent”, in relation to a child or young person, includes any person—

who is not a parent of his but who has parental responsibility for him, or (b) who has care of him. (Education Act 1996 sec.576)

Absence from School for Exceptional Circumstances Request Form

Child's Name:

Date of birth:

School Name

Year/Class

Child 2 Name:

Child 2 Date of birth:

Child 2 School Name

Child 2 Year/Class

Child 3 Name:

Child 3 Date of birth:

Child 3 School Name

Child 3 Year/Class

Parental Full Name

Parents Telephone Number

Parental DOB

Parental Full Name 2

Parents Telephone Number 2

Parental DOB 2

Home Address of parent(s) responsible for this absence

Email address

I request permission for my child/ren to be absent from school between:

Date of first day of school absence

Date of return to school

Total of days absent from school

All requests should be discussed with the Headteacher prior to submitting this form. Please detail below the reason for your request for absence from school in term time and include any supporting information.

The Headteacher will not be able to consider your request without your supporting documents. Please read carefully the Absence from School for Exceptional Circumstances Information for Parents.

Please note the school day is divided into 2 registration periods, for example if your child is absent for one day this equals 2 sessions and a five day absence equals 10 sessions.

Parent’s Declaration: I have read the Absence from School for Exceptional Circumstances Information for Parents and understand I/we may receive a penalty notice if my/our child receives unauthorised school absence as a result of this request.

Parent/Carer Full Name:

Parent/Carer signature

Date:

Parent/Carer 2 Name:

Parent/Carer 2 signature

Date

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