Request for Exceptional Leave of Absence for a Waycroft Multi-Academy Trust pupil. Please note: (1) the circumstances will not be authorised unless the Headteacher agrees that they are ‘exceptional’ and (2) this form should be completed and returned to the school (prior to making any travel plans), with an explanation as to why the requested leave of absence is due to ‘exceptional circumstances.’
Pupil’s Name……………………………………………………………………………………………………..………………..… Class…………………………………………………………………………………….……………………………………………….. from………………………………………………………………. (first day of absence)
to…………………………………………………………………… (last day of absence) One day of absence = 2 sessions
Please provide the ‘exceptional’ reason for requesting leave of absence
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(Please continue overleaf if necessary)
If you wish to discuss your ‘leave of absence’ request, please make an appointment to see the Headteacher.
I (We) have read the school’s Attendance Policy and I (We) understand the regulations concerning leave of absence. Signature of Parent/Carer………………………………………………………………………………….
Date…………………………………………………………………………………………………………. …….
If circumstances are not considered ‘exceptional’ and the leave of absence is for 8 sessions or more (4 days of school) within a 10 week period, a Penalty Notice is likely to be issued under Section 444 (1) of the Education Act 1996 to each parent for each child in accordance with current Government legislation.
Parents/Carers commit an offence if a child does not attend school regularly and/or absence is not agreed by the school.
The Local Authority retains overall responsibility for Penalty Notices being issued and will instigate legal proceedings if the Penalty Notice is not paid.
The money received from the payment of the Penalty Notice does not come to Waycroft Multi Academy Trust- it is retained by Bristol City Council.
For office use only:
Percentage attendance for the previous academic year =
Percentage attendance for the current academic year =
Total sessions requested for this leave of absence =
Circumstances Authorised/Unauthorised
Penalty Notice Referral Yes/No
Signature of SLT (Headteacher or Executive Leader)
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Date ………………………………………….
