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*

Student First NameStudent Last Name
Birth Date *

MonthDayYear
Current School*
Current Grade*

N/A4 Year Old Preschool (Half Day)4 Year Old Preschool (Full Day)K12345678
Entering Grade*

4 Year Old Preschool (Half Day)4 Year Old Preschool (Full Day)K12345678
Parent / Guardian Name*

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

Street Address

CityState

Zip Code
I hereby authorize Name of Prior School* to release the following records for my child, Name of Student*:
ALL OF THE BELOWOngoing Transcripts and Report CardsDiscipline RecordsTest Data / Standardized Test ScoresImmunization RecordsEnglish Language (ELL) Test Score (If ApplicableHealth / Medical RecordsList of Courses and Grades at Time of WithdrawalSport / Physical DocumentationOngoing Attendance RecordsPsychological / Psychiatric Evaluation Records (If Applicable)IEP (Individualized Education Plan) If ApplicableCopy of Birth Certificate504 Plan (If Applicable)PA Secure I.D. NumberMost 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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