Records Release

Records Release Request
To Releasing School*
School Requesting Information
North Gwinnett Christian Academy
15 E Moreno Street
Buford, GA 30518
Fax # 770-271-9794
Phone # 770-271-8979
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Registrars Email
example@example.com
School Telephone Number
Please enter a valid phone number.
School Fax Number
Please enter a valid phone number.
The below referenced student is enrolling into North Gwinnett Christian Academy. Please provide the requested information as indicated to expedite this enrollment process.
Student Name (Last, First, Middle)*
Birth Date*

MonthDayYear
Date
Parent/Legal Guardian (Last, First)*
Relationship
Parent/Legal Guardian (Last, First)*
Relationship
I hereby authorize the above referenced school to release all requested records to the requesting school without hesitation or delay.
Parent/Legal Guardian Signature*

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Date*

MonthDayYear
Date
Should be Empty:

Records Release Request