Student/Parent Rights (please read before signing): You may requets multiple releases of information identified on this authorization form. You may receieve a copy of this authorization. Fond du Lac School District does not condition treatment or eligibility for benefits based on the signing of this authorization. You have the right to inspect and receive a copy of the material to be disclosed in accordance with District policies. The District may charge for photocopies based on School Board policies. You may revoke this authorization at any time (except to the extent that the District has already acted in reliance upon it), by written notice to Fond du Lac School District.
Attn: Privacy Officer. If the person or organization requesting this information is not subject to the Federal privacy standards, the information disclosed pursuant to this authorization may no longer be protected by the Federal privacy standards. A photocopy of this authorization shall be as valid as the original.
I hereby release the Fond du Lac School District from all legal responsibilities that may arise from this act of disclosure.