Application: Student Exemption From Attendance - Elite Sport or Arts Program

The following is an Application of Student Exemption from Attendance - Elite Sport or Elite Arts Program. It is to be completed by the student's parent/carer.

Parent/Carer Details

Parent/Carer First Name

Parent/Carer Last Name

Parent/Carer Email

Parent/Carer Mobile 10 digits with no spaces.

Relationship To Student

Student Details

Student First Name

Student Last Name

Student Date of Birth

Student Year Level

Student Home Address

Suburb

State

Postcode

Exemption Details

Reason for Application for Exemption

Name of elite arts or elite sport program

Additional Information

Supporting DocumentationA schedule of participation, training or tour itinerary from the arts body or sporting body (eg. Australian Institute of Sport) or other equivalent documentation must be attached with contact names and numbers. NOTE: Where the reason for application for exemption includes travel arrangements for participants in the elite arts or sports event/program, copies of travel documentation should be included with the application as the school requires evidence of the student’s travel.

Exemption Details

Exemption Period Type

Total Number of School Days

a) Consecutive Days

a) Dates of Exemption Applied For (Start) Use this option ONLY if exemption is for consecutive days.

a) Dates of Exemption Applied For (End)

b) Non Consecutive Days

b) Date of first full school days applied for (Start) Use this option ONLY if exemption is NOT consecutive days.

b) Date of last full school days applied for (End)

Additional Details: Please provide additional details as to the exact non-consecutive dates within the period specified that require exemption.

c) Part Time - Partial Exemption

c) Date of first part-time school days applied for (Start) Use this option ONLY if exemption is part time.

c) Date of last part-time school days applied for (End)

c) Hours of Exemption (Total)

Additional Details: Please provide additional details as to the exact part-time dates as specified above, and hours that require exemption.

Details of Prior / Current Exemptions

Prior / Current Exemptions Start If applicable.

Prior / Current Exemptions End If applicable.

Copy of prior/current Certificate of Exemption attached

Number of Days (Total)

Parent Declaration

Parent Declaration As the parent/carer of the above mentioned student, I hereby apply for a Certificate of Exemption from attendance at school, under the Education Act 1990. I understand that if the exemption is granted: (a) I am responsible for their supervision during the period of exemption; (b) the exemption is limited to the period indicated; (c) the exemption is subject to the conditions listed on the Certificate of Exemption; (d) the exemption may be cancelled at any time. I declare the information provided in this application for a certificate of exemption 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 exemption may result in the exemption being revoked.

I Agree

Class Assessment Declaration Leave is conditional upon parents making alternative arrangements with their child’s teacher(s) regarding any class work and/or assessments that will be missed during the time of their leave. This communication is expected to occur prior to the leave being taken. This absence may affect Academic reports.

I Agree