Vacation Leave Request Form

Parents/guardians may use this form to submit vacation leave information to a student. You can:

            1) E-mail the form online; click "Submit Now" button to send.
            2) Print and fax (804) 443-3069 to Keith Krusz, Dean for School Life.
            3) Print and mail to Keith Krusz, SMS, PO Box 158, Tappahannock VA 22560.

      Use TAB to move between fields. Do NOT use ENTER until you have completed the form!
      If you click ENTER by accident, just click BACK to goback to the form in progress.

 

  
STUDENT AND VACATION INFO
Student's Name: Vacation:  
Departure Date: Return Date:
ADULT RESPONSIBLE FOR STUDENT DURING THE LEAVE
Name: Relationship to Student:
Full Address:
E-mail: Phone #:
ADULT TRAVELLING WITH STUDENT TO AND FROM SCHOOL
Name of Adult, even if parent of guardian, with whom the student will travel to and from school
Name: Phone #:
TRANSPORTATION INFORMATION
Please note: Groome Transportation Company will provide school transportation to the Washington Airports. Early morning departures / arrivals and late evening departures / arrivals to the Richmond Airport and Train Station will be provided by Grome Transportation Company.
Method Departure Return
CAR Departure date: Return Date:
Departure time: Return Time:
Driver: Driver:
AIR Departure Airport: Returning Airport:
Airline: Flight # Airline: Flight #
Departure date: Return Date:
Departure time: Return Time:
Train
Richmond Amtrak
Station
 		Train # Train #
Departure date: Return Date:
Departure time: Return Time:
Additional or
other travel info:
STOP - Section below to be signed by parent/guardian if mail in or fax
Forms sent via e-mail require a confirmation phone or voice message to Keith Krusz ext. 3026 or Donna Soule ext. 3030 at St. Margaret's School (804) 443-3357. You can call anytime day or night - key in extension number 3026 when requested and leave your confirmation - Thank You!.
Parent/Guardian Signature   Date: