Request Term-Time Leave

This form must be completed by parents / carers prior to a pupil's planned absence during term time.

Your Name (Person completing this form)* Your Relationship to the Pupil(s)* Child(ren)'s Name* Absence Start Date* Pupil Date of Return to School* If your child will be collected from school, please let us know the time Please Explain the Reason for the Requested Absence For Medical Appointments: Please Upload a Photo of the Appointment Letter No file chosen

Please tick to confirm*I have read the 'Term-Time Leave Requests' page on the school website and understand that absences may only be authorised by the School Management team in exceptional circumstances. Any subsequent leave taken, where permission is not given, will be marked as unauthorised and as such details may be passed on to Somerset Council where a fine may be issued.