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23 pagesrevision 49213
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21 | P a g e
STUDENT LEAVE AND TRAVEL FORM
To be completed by the student and handed to a matron or patron for approval and
forwarding to the Head of Boarding for issue of a Gate Pass.
(1) Boarder Details
Student’s Name: ____________________________________
Class: __________________
Parents’ Name: ______________________ Contact Number: ________________
(2) Requested Leave Arrangement
Leave Day: _________________ Time:__________
Return Day: ________________ Time:__________
Host’s Name: _____________________________________ (if applicable)
Host’s Address: ___________________________________(if applicable)
Purpose of Leave: ____________________________________________________
(3) Mode of Travel
From School _____________________
Return to School _________________
Housemaster/mistress ____________________
Date
Principal
________________ Date