Release of Records Parent Request Form

Release of Records Parent Request Form

All requests take five (5) business days to complete.
Student 1 Name*
Student 1 Grade*
Student 1 Birthdate*

MonthDayYear
Date
Student 2 Name
Student 2 Grade
Student 2 Birthdate

MonthDayYear
Date
Student 3 Name
Student 3 Grade
Student 3 Birthdate

MonthDayYear
Date
Student 4 Name
Student 4 Grade
Student 4 Birthdate

MonthDayYear
Date
Teacher
Report Card(s)/GradesImmunization/WaiverGeneral Education Cumulative FileSPED Education FileGeneral Education Cumulative File and SPED Education FileOther
Mail to:
Mailing Address
Email to:
Email Address
example@example.com
Thank you for your assistance,
Parent Name*
Signature*

Clear
955 Stanislaus Street, Maricopa CA 93252
Should be Empty: