Kingsthorpe Grove Primary School

Request for leave of absence form

We understand that at times there may be a need to take your child out of school during term times, medical appointment that you cannot get out of school hours, close family funeral, visiting a new school etc.

Regarding holidays, during term time we will not be able to authorise these and they may result in being referred to the Local Authority.

“If you take your child out of school for an accumulative total of 5 days or more (10 sessions) (83.33%) over a period of six weeks, the school will deem this as irregular attendance and will consider a referral to the Local authority for consideration of legal action. This could include,

A Penalty Notice payable up to £160 fine without further reference to you for a penalty notice this warning is valid for 12 months.

Prosecution under s444 (1) Education Act 1996, where if convicted you may be fined up to £1,000.

Prosecution under s444 (1) (a) Education Act 1996 where if convicted you may be fined up to £2,500 and/or 3 months’ imprisonment.”

Name of Pupil *

Class *

What is the nature of this absence? *

Medical Appointment

Other Absence Request

Appointment Type *

Date of appointment *

Location of appointment *

Proof of appointment (upload a photo of the text received from the provider) *

Drag and drop files here or Browse

Name of Adults accompanying Child *

Start date for absence *

Choose the first day of absence

Return to School Date *

Choose the return date

Days Absent requested (inc weekends/holidays)

Reason for request (please include as much information as possible to help us make a decision) *

During your child's time at Kingsthorpe Grove have you made such a request in the past? *

Yes

No

Signature *

Upcoming in School

AF 2

Request for leave of absence form