MANHATTAN CHRISTIAN ACADEMY

401 WEST 205TH STREET NEW YORK, NY 10034

TEL (212) 567-5521  FAX (212) 567-2815

RECORDS RELEASE FORM

Student's Name ________________________________________

Date of Birth ________________________ Grade _________

PLEASE GIVE US THE COMPLETE NAME AND ADDRESS OF THE SCHOOL YOUR CHILD LAST ATTENDED.

_________________________________________________

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PARENT'S SIGNATURE _____________________________________

                                                                                                         Date _____________ 

To Whom It May Concern:

Please forward the permanent records, both scholastic and medical, for __________________________________, who has recently entered our school.

Please include any deficiency reports, grades and remarks. Any questions please call at the above number.

                                                                                                                                              Thank you,

                                                                                                                                                  Nancy Betances

                                                                                                                                                  School Secretary