• Records Authorization Release Form

    Parent/Guardian authorizing the release of student's school records
  • Student's Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Authorization for Release of Official Records

    I as parent/guardian of the student identified above, hereby give permission to release official school records and transcripts, including:

    __X__  An unofficial transcript via fax or email 

    __X__  Birth Certificate via fax or email

    __X__  Disciplinary actions and administrative contacts via fax or email

    __X__  Immunization Records via fax or email

    __X__  Results of any standardized testing, psychological testing, and non-standard evaluations, accomodation plans, 504 plans and/or IEPs via fax or email

    _____   An official transcript via U.S. mail - To be completed by Valley Lutheran (if needed)

    I authorize your staff to discuss these records with the admissions staff of Valley Lutheran High School.  I authorize your staff to fax or email all documents other than the offcial transcript, which I understand is to be sent via U.S. mail.

    Federal Law 99:31: No parent signature is required for educational records sent to another educational agency.

    Valley Lutheran High School

    Email:  Admissions@VLHS.org

    Fax:  602-230-1602

    Address:  5199 N. 7th Avenue, Phoenix, Arizona 85012

  • Format: (000) 000-0000.
  • Signature Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: