Records Release Form
Please forward
student records to:
Synergy Prep
600 Baptist Camp Road
Griffin, GA 30223
770-227-8966 phone
678-814-1330 fax
Date
MM
/
DD
/
YYYY
Student Full Legal Name
Student Birthdate
MM
/
DD
/
YYYY
Documents Requested
-Transcript
-Attendance Records
-Discipline Records
-Standardized Testing Scores
-Birth Certificate, Immunization Records
-Special Education Documents (if applicable)
I authorize the release of these requested records to Skipstone Academy.
Parent / Guardian Name
Parent / Guardian Signature
Clear
SUBMIT FORM
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