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Parental Leave Request Form Template

Streamline Parental Leave Requests for Your Team

Submitting a parental leave request can be overwhelming for both employees and HR teams. This template is designed to simplify the process, helping employees easily request maternity or paternity leave while ensuring that their needs are met. With clear fields for important details, compliance with HR policies, and the ability to customize for various scenarios, you can facilitate smoother communication, track requests efficiently, and maintain compliance with existing regulations. Experience a hassle-free way for your team to manage parental leave-try using the live template now.

Full legal name
Employee ID
Department or team
Work email
Manager full name
Manager email
Your role in relation to the child
Birthing parent
Non-birthing parent or partner
Adoptive parent
Foster parent
Legal guardian
Intended parent (surrogacy)
Prefer not to say
Other
Please Specify:
Type of parental leave requested
Parental leave - continuous
Parental leave - intermittent
Pregnancy-related medical leave
Bonding leave
Adoption or placement leave
Foster care placement leave
Surrogacy-related leave
Other or unsure
Expected child arrival or placement date
Requested leave start date
Anticipated return-to-work date
Will you take leave in one continuous block?
Yes
No
If planning intermittent leave, outline your preferred schedule or pattern (if known)
Have you discussed this leave plan with your manager?
Yes
No
Do you plan to use accrued paid time off during this leave?
Yes, for the entire leave
Yes, for part of the leave
No
Unsure
If using paid time off, which types will you apply?
Vacation
Sick
Personal
Floating holiday
Parental leave bank
Not applicable or undecided
Other
Please Specify:
Are you applying for any of the following programs?
Company paid parental leave
State or provincial family leave
Short-term disability
Family and medical leave (job-protected, unpaid)
Not sure yet
Other
Please Specify:
I understand that pay and benefits during leave follow company policy and applicable law.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Preferred contact method during leave
Email
Phone call
Text message
None
Personal email for leave communications
Personal phone number for leave communications
Additional notes or considerations (optional)
Will you provide required documentation (e.g., birth certificate, placement papers, medical certification) upon request?
Yes
No
I certify that the information provided is accurate to the best of my knowledge.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Typed signature (enter full legal name)
Signature date
I understand this form is a request and does not constitute approval.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
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Paper art illustration depicting a parental leave request form with various icons and design elements related to family and caregiving.

When to use this form

Use this form when you need to plan time away for birth, adoption, foster placement, or surrogacy. It captures dates, eligibility, and coverage so you can approve leave, protect benefits, and keep operations running. People managers get clear handovers; employees get written confirmation, check-in expectations, and a return-to-work plan. If the time away will exceed your policy, pair it with a Request for leave of absence form. If the employee wants to add PTO around the start or end, direct them to the Time off request form. This template fits teams of any size and helps you coordinate payroll, staffing, and legal notices on one track.

Must Ask Parental Leave Request Questions

  1. What type of parental leave are you requesting (birth, adoption, foster, or surrogacy)?

    This confirms eligibility under your policy and any laws. It also routes the request to the right approvers and pay rules.

  2. What are your requested start and return dates, and the expected due or placement date?

    These dates let managers plan coverage, backfill, and training. They also drive benefit timelines and required notices.

  3. Will you take the leave continuously or intermittently, and for how many total weeks or days?

    This shapes staffing schedules and payroll. It avoids misunderstandings about partial days, phased returns, or split periods.

  4. Which duties need coverage, who is your primary backup, and when will you hand over?

    A clear handover reduces risk and keeps projects moving. It sets owners for critical tasks before the leave begins.

  5. What documentation will you provide (for example, medical certification or placement papers) and by what date?

    Collecting documents on time helps you stay compliant and speeds approval. If you coordinate with a general process, align fields with your Leave application form.

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