• Records Request

    To be completed by Parent or Legal Guardian
  • Birth date:   Pick a Date   Current Grade:      

  • School Transferring From:      
    School Office Phone Number:      
    School Office Email Address:      

  • 1. You are authorized to release the records listed below for the above named student to:
                               The CinDay Academy
                               11 Sycamore Creek Dr
                               Springboro, OH 45066
                                 (P) 937.748.1991
                     Email: sboyle@cindayacademy.com

    2. Please release ALL records. This includes, but not limited to:
                                          Grades
                                      Attendance
                                   Health Records
                              Standardized Test Scores
                              Psychological Evaluation
                               Evaluation Team Report
                                            I.E.P.
                           Behavior/Correction Reports
                                    Birth Certificate

    3. This form gives CDA authorization to contact via email, phone or text the student’s current school and teacher(s) for additional information.

  • Signature      Pick a Date   

  • Should be Empty: