RELEASE OF STUDENT RECORDS

I, __________________________________ (name), give my permission and request the release of student record information of my child, ___________________________ (child’s name), to be provided to me electronically by school personnel. The specific information and/or records requested are:

· Any pertinent concerns, including discipline, attendance, academic progress, etc. from my child’s teacher.

I understand that the transmittal of this material may not be available by secure methods and may be capable of observation, interception, or monitoring by others.

Further, I understand the District cannot guarantee that only the requester at the e-mail address provided will receive the records. I request that the student record information request above be sent to my electronic e-mail listed below.

Please return entire form to your child’s homeroom teacher.

Home Address: ___________________________

E-Mail Address: __________________________

Home Phone: ________________________ Work Phone: _____________________

Parent Signature: _____________________ Date: ____________________________

The teachers will be unable to specifically communicate with you via e-mail or fax regarding your child’s school progress without this form.