St Pius X School Windsor Gardens eNewsletter

Holiday Form 5 Days or more - Exemption from School Attendance ED175 Form C

PRINCIPAL APPROVED APPLICATION FOR EXEMPTION FROM SCHOOL

ENROLMENT/ATTENDANCE AND EDUCATION ENROLMENT/PARTICIPATION

Medical (up to one month)

Family / Travel / Holiday (up to 12 months)

Other / Conditional / Ongoing

For all students 17 years and under

Student Name *

Parent/Guardian Address *

Parent/Guardian Phone

Email *

Student's Date of Birth *

Age *

Gender *

Year Level *

Children and Young People in Care

Aboriginal/Torres Strait Islander

Student with Disability

Parent/Guardian Name *

Please select *

Family / Travel / Holiday (up to 12 months)

Other/ Conditional (up to one month) eg Covid restrictions

Ongoing Medical (up to one month)

Start Date *

End Date *

Parent/Guardian Signature *

Write your signature above the line

This form will be submitted to the Principal for approval.

Principal Signature: