Warilla High School

Application for Extended Leave - Travel

This form is to be completed by the student's parent and returned to their child's school principal. Separate applications are to be completed for each school if siblings do not attend the same school.

Student Details

Student full name *

Student date of birth *

Student full name

Student date of birth

Student full name

Student date of birth

Student full name

Student date of birth

Student full name

Student date of birth

Student address *

Dates of extended leave applied for

From *

To *

Number of school days *

Reason for travel *

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

Relevant travel documentation in support of this application must be uploaded here *

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Details of prior exemptions/extended leave - travel (if applicable)

Date of prior exemption/extended leave

From

Number of school days

Copy of Certificate of Exemption/Extended Leave - Travel attached

Attach file

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Parent details (applicant)

Applicant full name *

Phone number

Address *

Relationship to student *

Applicant email address *

As the parent and applicant, I hereby apply for a Certificate of Extended Leave - 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 - Travel
The 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 to be false of 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 - Travel may result in the provided period of extended leave being cancelled.

Signature *

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Date *

Privacy Statement

The Department of Education is subject to the Privacy and Personal Information Protection Act 1998. The information that you provide will be used to process your child's Application for Extended Leave - Travel during the period indicated.

It will only be used or disclosed for the following purposes:

General student administration relating to the education and welfare of the student
Communication with students and parents
To ensure the health, safety and welfare of students, staff and visitors to the school
State and National reporting purposes
For any other purpose required by law

The information will be stored securely. You may access or correct any personal information by contacting the school. If you have a concern or complaint about the way your personal information has been collected, used or disclosed, you should contact the school.