Holidays in Term-Time Request Form

REQUEST FOR TERM-TIME LEAVE
Please make your holiday request prior to making any flight or accommodation bookings and at least four weeks before the anticipated start date of your proposed holiday.

__________________________________________________________________________________

To the Principal - Ansford Academy

I wish to apply for term time leave for my child/children.

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Start Date (inclusive *

Day Month Year
Date
End Date (inclusive) *

Day Month Year
Date
Student Name *

First Name Last Name
Tutor Group *
Student Name

First Name Last Name
Tutor Group
Student Name

First Name Last Name
Tutor Group
The Exceptional Reasons for the Holiday Request are: *
Parent/Guardian *

Title First Name Last Name
Phone Number *

Area Code Phone Number
Mobile Number

Area Code Phone Number
E-mail *
Please Note

If the school refuses your holiday request and the child is still taken out of school, this will be recorded as an unauthorised absence.

This may result in a penalty notice being issued or legal action taken for poor attendance.
Should be Empty:

REQUEST FOR TERM-TIME LEAVE