School Records Release Form - St. Joseph's Indian School Kids

"*" indicates required fields

Student Name*

First Middle Last

Name of School Last Attended*

Grade*

Please enter a number from 1 to 12.

School Address*

Street Address Address Line 2 City State ZIP Code

I agree to have the school release the following records*

Cumulative records

Transcript/report card/checkout grades

Disciplinary records

Special education records

Immunization/health records

Attendance

Standardized tests

Copies of birth certificate, social security card

School Phone*

School Fax

As the parent/guardian of the above named child, I grant my permission for the school listed above to release information to St. Joseph's Indian School, Chamberlain, SD; for the purpose of determining if my child should be admitted to St. Joseph's Indian School. I understand that this release is valid until it is revoked in writing by me. I also understand that the collection of this information does not mean my child has been admitted to St. Joseph's Indian School, but only that admission is being considered.

Parent/Guardian Signature*

Print Name of Parent/Guardian

(2) Parent/Guardian Signature

Print Name of Parent/Guardian

Parent/Guardian Email*

According to the Final Regulations-Family Educational Rights and Privacy Act (Buckley Amendment), June 17, 1976, it is no longer necessary to obtain consent to release records. It states that school officials of other schools in school systems in which the student may intend to enroll, may receive a student’s record without a written consent for such release.