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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
Date Picker Icon
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:
*
Clear
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