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PRINCIPAL APPROVED APPLICATION FOR EXEMPTION FROM SCHOOL ENROLMENT/ATTENDANCE AND EDUCATION ENROLMENT/PARTICIPATION
FOR ALL STUDENTS UP TO 17 YEARS
Name of Student (in full)EDID MERGEFIELD EDID
School/Provider MERGEFIELD SchoolName HALLETT COVE SCHOOLSite No: MERGEFIELD SchoolNumber 0640 Principals NameTONY HALL
Parent/Guardian AddressParent/Guardian PhonePostcode MERGEFIELD Postcode Students Date of BirthAgeGenderYear Level MERGEFIELD YearLevel GOMYes / NoATSIYes /NoSWDYes / NoName of Parent/GuardianSignature
Temporary Period of Exemption
FORMCHECKBOX Family Travel/Holiday Up to 12 months
(Copy of itinerary/flight booking to be kept on school file)Destination
Start DateEnd Date
FORMCHECKBOX Other/Conditional/Part time Up to 1 month
(Copy of documentation to be kept on school file)Destination
Start DateEnd Date
FORMCHECKBOX Medical Up to 1 month
(Copy of recent medical support letter to be kept on school file)Destination
Start DateEnd Date
PRINCIPAL APPROVED / NOT APPROVED
(please circle)
Signature ____________________________ Date____/____/____
Please retain with all relevant supporting documents at school in student file for audit purposes
Print Principal Name: TONY HALL
FORM C
Updated: Aug 2023
The student must attend school regularly until exemption is approved.
Information provided is protected by section 137 of the Education and Childrens Services Act 2019.
For information regarding the exemption processes see HYPERLINK "https://www.sa.gov.au/topics/education-and-learning/schools/school-life/exemption-from-attending-school" SA.GOV.AU - Exemption from attending school (www.sa.gov.au)
COMPULSORY INFORMATION all fields must be completed - Please retain at school in student file
Principal Approved temporary period of exemption
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