• THE GLADYS H. OBERLE SCHOOL
    404 Willis Street
    Fredericksburg, VA 22401
    540.372.6710 (Office) 540.373.1791 (Fax)

     

  • AUTHORIZATION TO RELEASE INFORMATION

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  • I am aware that my records are protected under the Federal Confidentiality Regulations and cannot be disclosed without my written consent unless otherwise provided for in the regulations. I hereby release ERI or its representatives from all legal responsibilities or liability that may arise from this act. I understand that this consent may be revoked by me at any time by providing written notice to ERI or its representative. I further understand that information released prior to any revocation cannot be retrieved nor can ERI or its representatives be held responsible for such an act. In any event, this consent expires automatically when the above student is no longer enrolled in The Gladys H. Oberle School or July 31, 2022, whichever comes first.

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