View form Illawarra Christian School

Application for Exemption from Attendance at School

Fields marked with * are required

All Applications for Exemption from Attendance at School must be completed at least 2 weeks before the anticipated absence.

Student name *

Student date of birth *

Current grade *

Exemption from this date *

What is the first school day the student will be absent?

Exemption to this date *

What is the last school day the student will be absent?

Number of days applied for *

3-99 days

100 days or more

Reason for exemption *

Further details *

Please provide further details about the reason for the application for exemption here.

Has the student been granted a previous exemption already this year? *

Yes

Unsure

Parent details

Parent/Guardian Name *

As the parent/guardian of the above-named student, I hereby apply for a Certificate of Exemption from Attendance at School, under the Education Act 1990. I understand that if an exemption is granted:

I am responsible for the student's supervision during the period of exemption
the exemption is limited to the period indicated
the exemption is subject to the conditions listed on the Certificate of Exemption
the exemption may be cancelled at any time

I declare that the information provided in this application is accurate and complete to the best of my knowledge. 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 exemption may result in the exemption being revoked.

Parent/Guardian Signature *