Withdrawal & Consent to Release Records

This is to authorize Maryville City Schools to release student records on:

Student's Name (Last, First Middle)*required

Date of Birth (mm/dd/yyyy)*required

Current Grade*required

Parent's Name*required

Parent Email Address*required

Last Day at CGIS*required (mm/dd/yyyy)

Release Records To:

New School*required

City of New School*required

State of New School*required