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
I formally request a copy of my child’s/children’s following records

Other
Please provide copies via
Mailing Address
Please provide copies via
Email Address
example@example.com
Thank you for your assistance,
Parent Name
Signature
955 Stanislaus Street, Maricopa CA 93252
Should be Empty: