FAMILY HOLIDAY DURING TERM TIME Penalty Notice Request Form

FAMILY HOLIDAY DURING TERM TIME

Penalty Notice Request Form

All sections are mandatoryForm is more legible if typed

Referrers Details
Name / Email
School/ Academy
Address
Under the Leicestershire County Council Penalty Notice Code of Conduct (August 2013), I request Penalty Notice(s) to be issued to the following parent(s):
Title, First name and Surname of Parent(s) / Address / Contact Telephone Number
1.
2.
Name(s) of Pupil(s) / DOB / Gender / NCY / Lives with
1. / M / F
2. / M / F
3. / M / F
Any known previous Penalty Notices for parents for any of their children / None /
Not known / Yes.Date issued
Child’s name if not listed above

Confirm that the following documentation is being provided to support this request

Evidence for Court Officer / Evidence attached/comment
Copy of holiday request (if applicable)
Copy of warning letter to parent(s) informing them that their family holiday request has been considered and that leave of absence will not be granted. This letter must also notify parent(s) that the matter will be referred to the Local Authority for Penalty Notices to be issued
Period that the unauthorised family holiday took place / From / To
Certificate of attendance relating to the period of complaint enclosed/attached - all relevant absences must be coded using the ‘G’ code and should fall within the last 6 months
Should the penalty notice be issued and unpaid, a prosecution will take place. A Statement of Witness (CJ Act 1967 Section 9, MC Act 1980, s5A (3)(a) and 5B Magistrates Court Rules 1981 Rule 70) will be provided by the LA on behalf of the school. The Headteacher must provide, if requested, a signed Certificate of Attendance to reflect the period of absence in question. The Headteacher may also need to be available to give evidence in court if deemed necessary / Name
Role
Date
Signed

This form can be emailed to the generic inbox address below. Please password protect the document (generic password in use)

Pupil Services Court Team, Children and Family Services

Leicestershire County Council, County Hall, Glenfield, Leicestershire LE3 8RF

Telephone: 0116 305 6743 Fax: 0116 305 6330 Email:

Paul Meredith, Director of Children and Family Services

Form updated 05/09/17