Westpark School - Clover Sites
Westpark School Student Record Release
Date:________________________________
I hereby give my consent for ________________________________ to release any information considered by the school to be relevant to the education of: Name of Student(s) ________________________________________________ ________________________________________________ ________________________________________________ _________________________________________________
The information is to be released to: Mr. B. Ferguson, Principal Westpark School 2375B Saskatchewan Ave. W Portage la Prairie, MB R1N 4A6
Information may include communication with school personnel such as the guidance counsellor or resource teacher.
____________________________________
___________________________
Parent/Guardian Signature
Date
2375B Saskatchewan Ave. West, Portage la Prairie, Manitoba, Canada R1N 4A6 Phone: 204.857.3726 Fax: 204.239.6545 email: [email protected]
“Turning The World Up Side Down”
Date:________________________________
I hereby give my consent for ________________________________ to release any information considered by the school to be relevant to the education of: Name of Student(s) ________________________________________________ ________________________________________________ ________________________________________________ _________________________________________________
The information is to be released to: Mr. B. Ferguson, Principal Westpark School 2375B Saskatchewan Ave. W Portage la Prairie, MB R1N 4A6
Information may include communication with school personnel such as the guidance counsellor or resource teacher.
____________________________________
___________________________
Parent/Guardian Signature
Date
2375B Saskatchewan Ave. West, Portage la Prairie, Manitoba, Canada R1N 4A6 Phone: 204.857.3726 Fax: 204.239.6545 email: [email protected]
“Turning The World Up Side Down”
