Request for Leave of Absence

Complete the form below to request for a leave of absence.

You will receive a decision by letter or email usually within three working days of the request.

If you need to speak to someone regarding this contact Mrs Dickens on 01384 296596 or gdickens@kingswinford.windsoracademytrust.org.uk

Your email *

Child's first name *

Child's last name *

Child's date of birth *

Do you want to add siblings? *

Child's first name *

Child's last name *

Child's date of birth *

Do you want to add another sibling? *

Child's first name *

Child's last name *

Child's date of birth *

When would you like the leave to start from? *

When would the leave end? *

How many school days will your children be missing? *

What is the reason for the leave? *

By signing this form I understand the following:

1. The absences in line with the recent amendment to Pupil Regulations will not be authorised unless the Headteacher agrees that there are special 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.

Your name *

Your relationship to the child *

Your phone number *

Name of each adult who has parental responsibility for the children *

Address if different to the children