Southern Regional High School
Release Form For Child Study Team Records for Past Graduates

* Required Field 

Name (At the Time of Graduation):*

Year of Graduation:*  Date of Birth:*

RECORDS WILL BE AVIALABLE OR MAILED WITHIN 48 HOURS.

For School or Business Use:

School or Business Name:*

Address:*

City:* State:* Zip:*

For personal use.

Name:*

Address:*

City:* State:* Zip:*

Your present contact phone number or email if we need to contact you:

Comments:

I hereby authorize the release of my school records.