Leave of Absence Request Form

Jesus said, I have come that you should have life, life in all its fullness. John, 10:10






Requests for absence should be submitted as soon as you are aware of the need for leave &, where possible, not less than two weeks prior to the start of the absence. Forms not received within this timescale may not be considered. Proof (doctor’s note, prescription etc) will be required for children who are absent from school with sickness the day before or the day after an unauthorised period of 4 days absence. If this is not provided the sickness will be unauthorised. 


The Trust’s policy is not to authorise holidays during term time. 


When requesting an absence during term time parents/carers are requested to consider the following:

  • By missing lessons will my child fall behind or fail to make progress?
  • Will missing lessons interfere with preparation for national tests in Yr2 & 6 or with GCSE / A Level study?
  • Has my child missed lessons during the school term due to ill health or other absences?


Penalty Notice


A Penalty Notice (PN) may be issued for 10 sessions of unauthorised absence within a 6 week period. This may include 5 consecutive school days (which may be either side of any school holiday) of unauthorised absence, which could include a term time absence or holiday. If this request is for 5 or more school days continuous leave and is not authorised it will automatically be referred to the Education Entitlement Service for a Fixed Penalty Notice to be issued. The initial fixed penalty notice is currently £60 per parent per child i.e. a 2 parent family with 2 children would be fined £240, which needs to be paid to the Local Authority within 21 days. If payment is received between 21 – 28 days of issue the fine rises to £120 per parent per child i.e. £480 for a 2 parent and 2 child family. If payment is not received within 28 days of issue you may be prosecuted for the offence of irregular attendance and could be subject to a fine of up to £1,000 on conviction.


Please note that the school does not receive any of this money.


Further information

For further information please refer to the School’s Attendance Policy and the Department of Education website: http://www.education.gov.uk/schools/pupilsupport/behaviour/attendance


Key dates

Statutory School Assessments / GCSE / A Levels are carried out during the months of May & June.

No requests for leave during this time for year groups affected will be considered


Name of parent/carer completing this form: *
Relationship to pupil: *
Name of pupil(s) *
Class/Tutor Group *

Name of pupil(s) at other Pathfinder Schools where absence is also being requested

Name of pupil(s)
Class/Tutor Group
From Date *
To Date *
Days Requested *
I request permission for my child(ren) named above to be absent from school for the following reasons (this must be completed) *
Parental confirmation-both boxes must be ticked otherwise this could delay your request.*
I have included/attached evidence (appointment card / letter / etc) to accompany this form as I understand that the school has a responsibility to know where my child is during term time
I understand the circumstances when a penalty notice may be issued.
I understand that proof (doctor’s note, prescription etc) will be required if my child is absent from school with sickness the day before or the day after an unauthorised period of 4 days absence and if this not provided the sickness will be unauthorised.
Date of Completion
Date of Completion
Name of Parent/Carer #1
Name of Parent/Carer #2
Your Email address *

Although we do not insist that both parents sign, the completed response form will be returned to both parents with parental responsibility if living at separate addresses

Please send a photo of your signature(s) and any supporting evidence *
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