Purpose of the Student Records Release Form
This form is used to authorize the release of a child’s educational records, including academic performance, attendance, health records, and other relevant information. It allows parents or guardians to specify which records can be released and to whom, ensuring compliance with privacy laws and protecting the student’s information.
Parent/Guardian Consent:
By signing this form, I, the undersigned parent or guardian of the above-named child, acknowledge and agree to the following:
- Authorization for Release
I authorize the release of the specified records to the recipient named above. I understand that these records may contain confidential information, and I consent to their disclosure for the purpose stated in this form.
- Duration of Consent
This authorization is valid for 90 days from the date of signature, unless I provide written notice to revoke it sooner. After this period, a new form will be required for any further release of records.
- Revocation of Consent
I understand that I may revoke this consent at any time by providing written notice to the school. However, I acknowledge that such revocation will not affect any actions taken prior to the receipt of the written revocation.
- Release of Liability
I release the school, its employees, and representatives from any liability or claims related to the release of the specified records, provided the release is in accordance with this authorization.
- Automatic Denial in Absence of Form
I understand that if this form is not completed and returned, the school will not release any records without my explicit consent.
- Questions and Clarifications
Any questions or concerns regarding the school’s student records policy or the release process can be directed to the Main Office at:
Address
Email
Phone Number
