Titchmarsh Church of England Primary School

Northamptonshire County

Council Education department

Leave of Absence to pupils to accompany Parents on Annual Holiday

Name(s) of child(ren)____________________________ ____________________________

Class or Year Group(s)___________________________

I request permission for the above named to be allowed to accompany me

on my annual holiday to___________________________

From (date)________________to__________________

My child(ren) will return to school on_________________

Signed

_______________ Parent/Guardian

Confirmed:

____________________Headteacher

____________________Date

………………………………………………………………………………………………………………………………………

Return Slip

I herby give authorisation for the Leave of Absence of:-

______________________

______________________

From__________________to___________________

____________________Headteacher

____________________Date