Permission to Release School Records

Central Cass Public School
802 5th Street N
Casselton, ND 58012

Phone: 701-347-5352
Fax: 701-347-5354

penny.saewert@k12.nd.us

YOU ARE HEREBY AUTHORIZED TO PROVIDE CENTRAL CASS SCHOOL THE COMPLETE SCHOOL RECORDS (attendance, scholastic achievement, testing scores, psychological tests, and health information) FOR THE FOLLOWING STUDENT:

Student's First Name *

Student's Last Name *

Date of Birth (MM/DD/YYYY) * +

Name of School Last Attended *

Address of School Last Attended *

Date Last Attended * +

Grade Level Last Attended *

I am aware that these school records are available for my inspection at any time and that I may receive a personal copy if requested.

Name and Relationship to Child *

Parent/Guardian's Signature
(Sign using your mouse or trackpad) *

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