Date:______________________

To Whom It May Concern:

I, __________________________________________________, parent/legal guardian of

___________________________________________________ do hereby give permission to

release my child’s (children’s) permanent records to myself.

Please mail the complete record or copy thereof to:

_________________________________________ Name

_________________________________________ Home School Name (if you use one)

_________________________________________ Street or PO Box Address

_________________________________________ City, State, and Zip

__________________________________________________________________________

Parent or Legal Guardian’s Signature Date

If you should have any questions or need additional information you may contact me at my home

telephone number, _____________________________________.

Thank you in advance for your kind assistance in this matter.

Sincerely,

_________________________________(Parent or Legal Guardian’s Signature)