Current Start Preview Complete Confirmation For Penalty Notices in respect of Unauthorised Leave of Absence (Holiday in Term Time)Provide copies of parent’s request for leave, if any, and school’s response if the request is refused.Provide copy of letter to the parent/carer if the parent did not make the request for leave but you have reason to believe the child was on holiday and you have warned them that, as a result, you will be referring to the LA for a penalty notice.Ensure you are referring for the parent/carer who took the child on holiday or absence of leave.Send in the referral as soon as the absence of leave has ended.Ensure the period of absence was for 5 days (10 sessions) or more. I agree and confirm the above statements have been considered prior to submitting this referral Headteacher details Name Customer name Title Title - Select -MissMsMrMrsDrOther… Enter other… First name Last name Contact Contact details Email Phone number Pupil 1 details Name Pupil 1 name Title Title - Select -MissMsMrMrsDrOther… Enter other… First name Last name Address Pupil 1 address First line of address Second line of address City/Town Postcode School details School name NCY Child known to Social Care? Yes No Name of allocated social worker Other details Date of birth Language spoken at home Language spoken at home - None -AfrikaansAmharicArabicAsturianAzerbaijaniBelarusianBulgarianBengaliTibetanBretonBosnianCatalanCzechWelshDanishGermanDzongkhaGreekEnglishEnglish, BritishEsperantoSpanishEstonianBasquePersian, FarsiFinnishFilipinoFaeroeseFrenchFrisian, WesternIrishScots GaelicGalicianSwiss GermanGujaratiHawaiianHebrewHindiCroatianHaitian CreoleHungarianArmenianIndonesianIcelandicItalianJapaneseJavaneseGeorgianKazakhKhmerKannadaKoreanKurdishKyrgyzLaoLithuanianLatvianMalagasyMacedonianMalayalamMongolianMarathiBahasa MalaysiaMalteseBurmeseNepaliDutchNorwegian BokmålNorwegian NynorskOccitanOdiaOssetianPunjabiPolishPersian, AfghanistanPashtoPortuguese, InternationalPortuguese, PortugalPortuguese, BrazilRohingyaRumantsch GrischunRomanianRussianKinyarwandaScotsNorthern SamiSinhalaSlovakSlovenianAlbanianSerbianSwedishSwahiliTamilTamil, Sri LankaTeluguThaiTurkishTuvanUyghurUkrainianUrduVietnameseLolspeakChinese, SimplifiedChinese, TraditionalOther… Enter other… To the best of your knowledge has the child moved into Wolverhampton in the last 3 years? - None -YesNo Name of Authority Add another pupil Pupil 2 details Name Pupil 2 name Title Title - Select -MissMsMrMrsDrOther… Enter other… First name Last name Address Pupil 2 address same as pupil 1 address Yes No Pupil 2 address First line of address Second line of address City/Town Postcode School details School name NCY Child known to Social Care? Yes No Name of allocated social worker Other details Date of birth Language spoken at home Language spoken at home - None -AfrikaansAmharicArabicAsturianAzerbaijaniBelarusianBulgarianBengaliTibetanBretonBosnianCatalanCzechWelshDanishGermanDzongkhaGreekEnglishEnglish, BritishEsperantoSpanishEstonianBasquePersian, FarsiFinnishFilipinoFaeroeseFrenchFrisian, WesternIrishScots GaelicGalicianSwiss GermanGujaratiHawaiianHebrewHindiCroatianHaitian CreoleHungarianArmenianIndonesianIcelandicItalianJapaneseJavaneseGeorgianKazakhKhmerKannadaKoreanKurdishKyrgyzLaoLithuanianLatvianMalagasyMacedonianMalayalamMongolianMarathiBahasa MalaysiaMalteseBurmeseNepaliDutchNorwegian BokmålNorwegian NynorskOccitanOdiaOssetianPunjabiPolishPersian, AfghanistanPashtoPortuguese, InternationalPortuguese, PortugalPortuguese, BrazilRohingyaRumantsch GrischunRomanianRussianKinyarwandaScotsNorthern SamiSinhalaSlovakSlovenianAlbanianSerbianSwedishSwahiliTamilTamil, Sri LankaTeluguThaiTurkishTuvanUyghurUkrainianUrduVietnameseLolspeakChinese, SimplifiedChinese, TraditionalOther… Enter other… To the best of your knowledge has the child moved into Wolverhampton in the last 3 years? - None -YesNo Name of Authority Add another pupil Pupil 3 details Name Pupil 3 name Title Title - Select -MissMsMrMrsDrOther… Enter other… First name Last name Address Pupil 3 address same as pupil 1 address Yes No Pupil 3 address First line of address Second line of address City/Town Postcode School details School name NCY Child known to Social Care? Yes No Name of allocated social worker Other details Date of birth Language spoken at home Language spoken at home - None -AfrikaansAmharicArabicAsturianAzerbaijaniBelarusianBulgarianBengaliTibetanBretonBosnianCatalanCzechWelshDanishGermanDzongkhaGreekEnglishEnglish, BritishEsperantoSpanishEstonianBasquePersian, FarsiFinnishFilipinoFaeroeseFrenchFrisian, WesternIrishScots GaelicGalicianSwiss GermanGujaratiHawaiianHebrewHindiCroatianHaitian CreoleHungarianArmenianIndonesianIcelandicItalianJapaneseJavaneseGeorgianKazakhKhmerKannadaKoreanKurdishKyrgyzLaoLithuanianLatvianMalagasyMacedonianMalayalamMongolianMarathiBahasa MalaysiaMalteseBurmeseNepaliDutchNorwegian BokmålNorwegian NynorskOccitanOdiaOssetianPunjabiPolishPersian, AfghanistanPashtoPortuguese, InternationalPortuguese, PortugalPortuguese, BrazilRohingyaRumantsch GrischunRomanianRussianKinyarwandaScotsNorthern SamiSinhalaSlovakSlovenianAlbanianSerbianSwedishSwahiliTamilTamil, Sri LankaTeluguThaiTurkishTuvanUyghurUkrainianUrduVietnameseLolspeakChinese, SimplifiedChinese, TraditionalOther… Enter other… To the best of your knowledge has the child moved into Wolverhampton in the last 3 years? - None -YesNo Name of Authority Add another pupil Pupil 4 details Name Pupil 4 name Title Title - Select -MissMsMrMrsDrOther… Enter other… First name Last name Address Pupil 4 address same as pupil 1 address Yes No Pupil 4 address First line of address Second line of address City/Town Postcode School details School name NCY Child known to Social Care? Yes No Name of allocated social worker Other details Date of birth Language spoken at home Language spoken at home - None -AfrikaansAmharicArabicAsturianAzerbaijaniBelarusianBulgarianBengaliTibetanBretonBosnianCatalanCzechWelshDanishGermanDzongkhaGreekEnglishEnglish, BritishEsperantoSpanishEstonianBasquePersian, FarsiFinnishFilipinoFaeroeseFrenchFrisian, WesternIrishScots GaelicGalicianSwiss GermanGujaratiHawaiianHebrewHindiCroatianHaitian CreoleHungarianArmenianIndonesianIcelandicItalianJapaneseJavaneseGeorgianKazakhKhmerKannadaKoreanKurdishKyrgyzLaoLithuanianLatvianMalagasyMacedonianMalayalamMongolianMarathiBahasa MalaysiaMalteseBurmeseNepaliDutchNorwegian BokmålNorwegian NynorskOccitanOdiaOssetianPunjabiPolishPersian, AfghanistanPashtoPortuguese, InternationalPortuguese, PortugalPortuguese, BrazilRohingyaRumantsch GrischunRomanianRussianKinyarwandaScotsNorthern SamiSinhalaSlovakSlovenianAlbanianSerbianSwedishSwahiliTamilTamil, Sri LankaTeluguThaiTurkishTuvanUyghurUkrainianUrduVietnameseLolspeakChinese, SimplifiedChinese, TraditionalOther… Enter other… To the best of your knowledge has the child moved into Wolverhampton in the last 3 years? - None -YesNo Name of Authority Parent/Carer 1 details Name Parent/Carer 1 name Title Title - Select -MissMsMrMrsDrOther… Enter other… First name Last name Address Parent/Carer 1 address same as pupil 1 address Yes No Parent/Carer 1 address First line of address Second line of address City/Town Postcode Contact Contact details Phone number Other details Date of birth Add second parent/carer Parent/Carer 2 details Name Parent/Carer 2 name Title Title - Select -MissMsMrMrsDrOther… Enter other… First name Last name Address Parent/Carer 2 address same as pupil 1 address Yes No Parent/Carer 2 address First line of address Second line of address City/Town Postcode Contact Contact details Phone number Other details Date of birth Information about this leave of absence Was permission for this absence requested in advance from parent/carers? Yes No Was permission given? Yes No Dates of unauthorised absence from Dates of unauthorised absence to Number of school days Minimum of 5 consecutive days Additional comments Documents Copy of the request for leave of absence (if applicable)? Copy of the letter to the parent/carers advising them that the leave was not authorised? Copy of the child/children’s attendance certificate showing G codes? 18871
