Records and Transcript Request Form

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Student Information

Student Name(Required)

Date of Birth(Required)

MM/DD/YYYY

Current Grade or Graduation Year(Required)

Records to be Released(Required)

Report Cards (Lower and Middle School)

Transcript (Upper School)

Attendance Records

Standardized Test Scores

Health Records

Teacher/Counselor Recommendations (form is required)

Other Records (fill in Special Handling Section)

Special Handling

Recipient Information

Recipient (School/Program/Recruitment)(Required)

Delivery (Address/Email Address)(Required)

City

State

Zip

Country

Authorization & Signature

I hereby authorize Miami Country Day School, its employees, managers and administrators to release the following information on behalf of my child to the school or program listed above. Records relating to attendance, academic, disciplinary, behavioral, medical, psychological, investigations, the reason for leaving, or any other information or records requested by schools to which I/We have submitted during the admission process on behalf of my child. I/We agree to hold the School, and its employees, managers, and administrators, harmless from and indemnify it/them against all claims, demands, suits, charges, attorney’s fees, costs, damages, liens, liabilities, and actions of any kind whatsoever (including, but not limited to, claims for breach of contract, under the Americans with Disabilities Act, under any state or federal civil rights law, or for defamation, negligence, invasion of privacy, etc.), arising out the School releasing information or records regarding my child.

Electronic Signature(Required)

Type your full name as your electronic signature.

Date Signed(Required)

Your Preferred Email or Phone Number(Required)

MCDS campus building, shown on the Records and Transcripts form page