Records & Transcript Request Form | Miami Country Day School

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Student Information

*Student Name:

*Date of Birth:

MM/DD/YYYY

*Current Grade or Graduation Year:

To select multiple options below, press and hold the option button on your keyboard while clicking multiple items.

*Records to be Released:

Special Handling:

Recipient Information

*Recipient (School/Program/Recruitment):

*Delivery (Address/Email Address):

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:

*Date Signed:

*Your Preferred Email or Phone Number:

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MCDS is an Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, age, religion, color, sex, national origin, marital status, sexual orientation, pregnancy, protected veteran status, or any other characteristic protected by Federal, State, or local laws.