Leave of Absence Form

Type of Absence*Holiday NotificationExceptional Circumstance

School* First Name of Child* Surname of Child* Date of Birth* Form* Address of Child* Postcode* Contact Number Parent/Carer (1) Full Name of Parent/Carer (1)* Address if different from Child Full Name of Parent/Carer (2) Address if different from Child Contact Number Parent/Carer (2)*

About the Request

Absence Date From* Absence Date To* Please give an explanation for taking your child out of school in term time.*

Would he/she miss any national tests?*YesNo

Emergency Telephone Contact Number* Parent/Carer's Signature*

*Please note that no absence will be authorised except in exceptional circumstances. A Fixed Penalty notice for holidays taken in term time will be issued by the Local Authority. *

The Rodillian Academy Trust shares the Government's determination to raise the levels of student attendance at school because we want to give the best future opportunity for all our students. As part of our efforts to support families, we have structured our terms, to allow opportunity to book holidays at non-peak times and prices. This includes a half term in June instead of the traditional May holiday week and returning to school at the end of August gives an additional week in October, giving two weeks half term instead of one. Please check your child's planner or the website for exact dates.