Consent for Release of Information Form

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Parent / Guardian Information

Parent / Guardian Name(Required)

Student Information

Student Name(Required)
Student Birthdate(Required)

I consent to the release of the following information:

  • Student Records (reports, letters, legal documents e.g.: copy of birth certificate, medical cards, court orders), Permanent Educational Records
  • Learning Assistance file (if applicable)
  • Confidential File (e.g. Psychology Reports Speech and Language Reports, Physiotherapy/Occupational Therapy Reports, Dr.’s letters, etc.) if applicable
Clear Signature