Miami Country Day School

Records & Transcript Request Form

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:

Miami Country Day School is a college preparatory learning community committed to educating the whole child. Through the core values of honor, respect, wisdom and compassion, we prepare students to be lifelong learners. We inspire our children to develop their intellectual, physical, aesthetic, social, emotional and spiritual potentials by valuing every student every day.

Every Student. Every Day.

601 NE 107th Street | Miami, FL 33161
PH: 305.779.7200 | F: 305.397.0370