Bridgeway
Academy
334 Second Street
Catasauqua, PA 18032-2501 |
Telephone: 610-266-9016
FAX: 610-266-7817 |
To Releasing Counselor: Date ______________
______________________________________________________________________
School Name
______________________________________________________________________
Address
City: _________________________________________ State: ____ Zip:
___________
Dear Counselor:
My children have been withdrawn from your school. Please release their
academic and health records to the following school. Thank you.
Bridgeway Academy
334 2nd Street
Catasauqua, PA 18032
Students' Names, Age, and Grade Level at withdrawal time:
| NAMES OF CHILDREN IN FAMILY WITHDRAWING |
|
AGE |
|
GRADE |
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| 1. ________________________________________ |
|
____ |
|
____ |
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| 2. ________________________________________ |
|
____ |
|
____ |
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| 3. ________________________________________ |
|
____ |
|
____ |
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| 4. ________________________________________ |
|
____ |
|
____ |
|
_____________________________________ |
____________________________ |
|
Signature of Requesting Parent |
Date |
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