Previous School Attended

School Name:
Address:
Phone Number:
Fax Number:
School District:

Child One

Name:
Grade (2018-2019):
Birth Date:
Please attach all records not requiring parent approval to George Washington Academy: standardized test results, health records, academic reports, etc.
File 1:
File 2:
File 3:
File 4:

Child Two (if applicable)

Name:
Grade (2018-2019):
Birth Date:
Please attach all records not requiring parent approval to George Washington Academy: standardized test results, health records, academic reports, etc.
File 1:
File 2:
File 3:
File 4:

Child Three (if applicable)

Name:
Grade (2018-2019):
Birth Date:
Please attach all records not requiring parent approval to George Washington Academy: standardized test results, health records, academic reports, etc.
File 1:
File 2:
File 3:
File 4:

Child Four (if applicable)

Name:
Grade (2018-2019):
Birth Date:
Please attach all records not requiring parent approval to George Washington Academy: standardized test results, health records, academic reports, etc.
File 1:
File 2:
File 3:
File 4:

Child Five (if applicable)

Name:
Grade (2018-2019):
Birth Date:
Please attach all records not requiring parent approval to George Washington Academy: standardized test results, health records, academic reports, etc.
File 1:
File 2:
File 3:
File 4:

In compliance with Family Education Rights and Privacy Act of 1974, which requires consent for the release of certain information, I hereby give consent for release to George Washington Academy the records and reports indicated below:
Special Education Records:
Psychological Reports:
Others as indicated:
Others: