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Parental Permission to Request or Release School Records for GCC 2021-22

I hereby authorize Greensburg Central Catholic Junior-Senior High to request and/or release records relative to my children's previous educational experiences.

First Parent/Guardian Name
First Name*
Last Name*
First Parent/Guardian Age Acknowledgment*
First Parent/Guardian Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Parent/Guardian Signature*
Second Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Third Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Fourth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Fifth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Sixth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Seventh Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Eighth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Ninth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Tenth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Name of Student
Full Name (First Middle Last) *
Student Date of Birth
Date of Birth *
Current School Attending
Current School *
Records Requested
Attendance Data
Report Cards (Past and Current)
Group Aptitude and Achievement Testing
Health, Medical and Dental Records
Personal History
Psychological Reports
Psychiatric Evaluations
Special Education Due Process Papers and IEP
Speech and Language Evaluations
Instructional Support Plans and Summaries
Others: (Specific reports, e.g., Occupational and Physical Therapists, Neurological Evaluations, etc. known by parents to be available) Please list below.
Others
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it.


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