Application for Extended Leave - Vacation/Travel Pform
ID:0 | 25/01/2021 |
Recipient: Guest
Originator: Guest
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1 1. Guest Info
1. Guest Info
2 2. PART A: STUDENT DETAILS
2. PART A: STUDENT DETAILS
3 3. PART B: APPLICANT DETAILS AND CONFIDENTIAL
3. PART B: APPLICANT DETAILS AND CONFIDENTIAL
4 4. HCS APPROVAL
4. HCS APPROVAL
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1
Guest Info

Full Name of Caregiver completing application: *

Email Address *
2
PART A

STUDENT INFORMATION

Please complete information below with details of all students associated with the period of travel:

Student/s Full Name: *


Family Code:

Student/s Year Level and Date of Birth: *

Student address: *

Will the student require access to their school email address during this period of leave? *

Dates of extended leave applied for from: *

to: *

Number of school days: *

Reason for travel: *

Relevant travel documentation such as an e-itinerary or itinerary (in the case of non-flight bound travel within Australia only) MUST be attached to this application.

IF YOU ARE TRAVELLING INTERNATIONALLY OR DOMESTICALLY BY FLIGHT, YOU MUST ATTACH AN E-TICKET. IF YOU ARE TRAVELLING DOMESTICALLY (E.G. ROADTRIP), YOU MAY ATTACH AN ITINERARY or complete the following question.

If you have not uploaded an e-tinerary or itinerary, please give details of your travel including but not limited to the mode of transport and specific destination. eg. Brisbane

PART A: DETAILS OF PRIOR EXEMPTIONS/EXTENDED LEAVE – VACATION/TRAVEL (if applicable)

Date of prior exemption/extended leave from:

to:

Number of school days:

Attach a copy of Certification of Exemption/Extended Leave
3
PART B

TO BE COMPLETED BY THE APPLICATN

TO BE COMPLETED BY THE APPLICANT

Parent or Caregiver Full Name/s: *


Address: *

Telephone number: *

Relationship to the student: *

As the parent/caregiver 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:

  • I am responsible for his/her supervision during the period of extended leave
  • The provided period of extended leave is limited to the period indicated
  • The provided period of extended leave is subject to the conditions listed on the Certificate of Extended Leave-Vacation/Travel
  • The period of extended leave will count towards my child’s absences from school
  • I agree to contact my child's teacher (preferably two weeks prior to leave) to arrange for work to be completed whilst on leave

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 to be 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. *

4
HCS APPROVAL

OFFICE USE ONLY





Principal Comment:




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