Student Release Form
This form authorizes the release of a student from school activities.
Student's Full Name
First Name
Last Name
Date of Birth
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian's Full Name
First Name
Last Name
Parent/Guardian's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian's Email Address
example@example.com
Reason for Release
Date & Time of Release
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Signature of Parent/Guardian
Submit
Should be Empty: