Application for Extended Leave

Application for Extended Leave - Vacation/Travel
Student Details
Please list all students associated with this period of leave (please use the 'Add another student' button below if you have multiple students)*
Will the student's listed above be in Primary or Secondary at the time of travel?*

PrimarySecondaryBoth
Student's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Details/Date of extended leave applied for:
Start Date of extended leave*

DayMonthYear
Date
End Date of extended leave*

DayMonthYear
Date
Number of school days*
Reason for travel*
Please upload relevant travel documentation such as an e-ticket or itinerary (in the case of non-flight bound travel within Australia)*

Cancelof
Details of previous Exemptions for Extended Leave - Vacation/Travel
Have any of the students listed above received previous exemptions from school for Extended Leave - Vacation Travel?*

YesNo
Date of prior exemption/extended leave From Date* to End Date*.
Total number of school days No. of days* they were absent.
Please upload a copy of the previous Certification of Exemption/Extended Leave - Travel

Cancelof

Parent/Carer Declaration
Declaration*

As the parent/carer and applicant, I hereby apply for a Certificate of Extended Leave - Vacation/Travel and understand my child will be granted a period of extended leave upon acceptance by the Principal of the reason provided.
I understand that if the application is accepted: (please tick all to acknowledge understanding)*

I am responsible for the student's supervision during the period of extended leaveThe provided period of extended leave is limited to the period indicatedThe provided period of extended leave is subject to the conditions listed on the Certificate of Extended Leave - Vacation/TravelThe period of extended leave will count towards my child's absences from school
I declare the information provided in this application is to the best of my knowledge and belief; accurate and complete. I recognise that should statements in this application later prove false or misleading any decision made as a result of this application may be reversed. I further recognise that a failure to comply with any condition set out in the Application for Extended Leave - Vacation/Travel may result in the provided period of extended leave being cancelled.*

Agree
Signature of parent

Clear
Date signed

DayMonthYear
Date

Application for Extended Leave - Vacation/Travel