Life Way Christian School Withdrawal Form printable pdf download

Life Way Christian School Withdrawal Form

Life Way Christian School

Withdrawal Form

Student Name_______________________________Date of Birth _____________Grade ______

Date of withdrawal (last day) _____________________

Reason of Withdrawal (Please Explain):

□ Academic Issues ______________________________________________________________

□ Discipline Issues ______________________________________________________________

□ Financial Issues _______________________________________________________________

□ Relocation ___________________________________________________________________

□ Other ______________________________________________________________________

Send Records To:

Parent/School Name ____________________________________________________________

Address _______________________________________________________________________

City

State

Zip

I give permission to release past and present academic records, standardized test scores,

attendance records, discipline records, immunization records, and special education records

and any other information that may be useful.

Parent/Guardian Signature___________________________________ Date ________________

Office Use Only:

Academic Account- All books and lock returned in good condition

□ Clear

Athletics Account- All uniforms returned in good condition

□ Clear

Library Account- All books returned in good condition

□ Clear

Tuition Account- All fees and tuition paid (Balance Due _____________)

□ Clear

Copies to: □ Principal

□ Administrator

□ Approved to Release Records

Administrator Signature ____________________________

□ Records Sent

Board Signature __________________________________

Life Way Christian School Withdrawal Form