Request for special or exceptional absence during term time

Henry Cavendish Primary School

REQUEST FOR SPECIAL OR EXCEPTIONAL ABSENCE DURING TERM TIME

TO BE COMPLETED BY PARENT / CARER Name(s) of child (ren):       Class (es):                               No. of days requested:      Last day at school:       Return to school date:       Reason for Special Absence Request (please note that, since a change in regulations in September 2013, requests for family holiday during term time will normally be declined). Please provide evidence to support your request, e.g., invitation, appointment card/letter, programme etc.       Please state any previous Special or Exceptional Absence requests in the current academic year:       Parent/Carer signature: Date:      

TO BE COMPLETED BY SCHOOL I am able to authorise your request for      day(s) Special absence Code:   I am unable to authorise your request for      day(s) Special absence Code:   Please note that a special absence request may not be granted if there have been previous requests for special absence, if a child is at a critical stage in his/her education, or if the child’s attendance is very low. Percentage attendance for your child in this academic year to date:      % (if relevant) Signature: Date:      

Absence Codes:
B - Educated off site, C - Other authorised circumstances, G - Family Holiday (not agreed), H - Family holiday (agreed), J – School Interview,
M - Medical/Dental appointments, O - Unauthorised circumstances, P - Approved sporting activity, R - Religious observance