South Hills Catholic Academy Records Release Form

South Hills Catholic Academy Records Release Form

Please Complete A Form For Each Student
Student's Full Name *

First Name Last Name
Birth Date *

Month Day Year
Current School *
Current Grade *
Entering Grade *
Parent / Guardian Name *

First Name Last Name
Parent / Guardian Email *
example@example.com
Relationship to Child *
Parent / Guardian Address *

Street Address

Street Address Line 2

City State

Zip Code
I hereby authorize Name of School* to release the following records for my child, Name of Student*:
ALL OF THE BELOW Ongoing Transcripts and Report Cards Discipline Records Test Data / Standardized Test Scores Immunization Records English Language (ELL) Test Score (If Applicable Health / Medical Records List of Courses and Grades at Time of Withdrawal Sport / Physical Documentation Ongoing Attendance Records Psychological / Psychiatric Evaluation Records (If Applicable) IEP (Individualized Education Plan) If Applicable Copy of Birth Certificate 504 Plan (If Applicable) PA Secure I.D. Number Most Recent Behavior Intervention Plan (If Applicable) Other
Please Sign

IMPORTANT: You must click "SUBMIT" after signing. If "SUBMIT" isn't clicked, we will not receive your document.
Please sign below: *

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