Authorization For Release Of Student Records

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Student Name*
First Last
Previous/current school:*
School Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent Name*
First Last
Signature*
By checking this box you authorize Mount Madonna School to request and receive the cumulative school file for the above named student from the above listed school.
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Phone
This field is for validation purposes and should be left unchanged.

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