SGS - Records Request Form - Permission 2024 - 2025

By my (our) signature below, I (we), as parent(s) or legal guardian of the student(s) listed below give permission to the school listed below to release the school records to St. Gabriel School. Please send the records to: St. Gabriel School 9935 Johnnycake Ridge Road Concord, OH 44060. You can also scan and email them to: Michelle.Clarke@st-gabrielschool.org

Student # 1 Name Student # 1 Name First Last
Date of Birth - Student # 1 Date of Birth - Student # 1 / MM / DD YYYY
Name of School to obtain Records
Student # 2 Name Student # 2 Name First Last
Date of Birth - Student # 2 Date of Birth - Student # 2 / MM / DD YYYY
Name of School to obtain Records
Student # 3 Name Student # 3 Name First Last
Date of Birth - Student # 3 Date of Birth - Student # 3 / MM / DD YYYY
Name of School to obtain Records
Student # 4 Name Student # 4 Name First Last
Date of Birth - Student # 4 Date of Birth - Student # 4 / MM / DD YYYY
Name of School to obtain Records
PLACE A CHECK BEFORE THE RECORDS AUTHORIZED TO BE RELEASED:

PLACE A CHECK BEFORE THE RECORDS AUTHORIZED TO BE RELEASED: Grades and Academic Records Psychologist Assessments and Records Disciplinary Records Attendance Records Medical Reports (Immunization Records/Screenings) Testing Results and/or Evaluations (MAP Reports / IOWA) Other, please specify
Information obtained will be used in a confidential and professional manner. Please send records to:

St. Gabriel School
9935 Johnnycake Ridge Road
Mentor, Ohio 44060
ATTN: Student Records

Phone # 440-352-6169
Fax # 440-639-0143
Email: Michelle.Clarke@st-gabrielschool.org

Draw your signature into the box below. (Parent/Legal Guardian)

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Today's Date Today's Date / MM / DD YYYY