Woodvale Primary Academy

Leave of Absence Request Form

Name of child(ren)*

Year Group(s)*NurseryReceptionYear 1Year 2Year 3Year 4Year 5Year 6

First day of absence from school* Last day of absence from school* Number of school days missed* Reason for absence*

Explanation of exceptional circumstances to be considered* Please upload any supporting evidence for your request No file chosen

Name of person completing the form* Relationship to child(ren)* Your email address*

Part of the Greenwood Academies Trust group of Academies