2026-2027 School Release
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2026-2027
School Release
Teens First Name
Teens Last Name
Teens School Name:
School Address
Address Line
City
Zip Code
School Phone
Parent/Guardian First Name
Parent/Guardian Last Name
Consent for School Visits and Two-Way Release of Information I authorize Remembrance Ranch and its employees or authorized representatives to communicate and meet with my teenager on school grounds during school hours at the school identified in this form. I also authorize the mutual exchange of information between Remembrance Ranch and the identified school. This allows: Remembrance Ranch to share relevant information and records with the school. The school to share relevant information and records with Remembrance Ranch. Information exchanged may include educational records, grades, attendance, behavior or disciplinary records, special education records or Individualized Education Programs (IEPs), referrals to other agencies, and relevant written or verbal communication. When applicable and legally permitted, information may also include records related to mental health services and substance-use diagnosis or treatment. I understand that this authorization is intended to help Remembrance Ranch staff, the student’s Family Advocate, and school personnel coordinate services and provide appropriate support for my teenager. By selecting “I Agree” and signing this form, I confirm that I am the student’s parent or legal guardian and authorize the school visits and two-way exchange of information described above.
Agree
Parent/Guardian Signature:
Sign Here
Date
Submit Form
