Authorization For Transfer Of Records

Authorization for Transfer of Records

Full Name of Student *

First Name *

Last Name *

Current School

First Name

Last Name

Address of School

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Authorization is hereby given for transfer of all school and health records for the above student.

Please mail records to:

AURA
1600 E Hill St. Signal Hill CA 90755

Signature of Parent or Guardian *

First Name *

Last Name *

E-mail *

Month

Date

Year

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