I, the parent/guardian of the student named below, do hereby authorize the Lincoln College Preparatory Academy School Advisory Committee (SAC) to publish the following information in the parent directory.
*I understand the directory will publish the information as I have
filled in the blanks below.
*I understand I may elect to omit some or all of the information;
*I understand I may further elect not to have any information published in the directory by simply not completing, signing, and returning this form.
*Each parent/guardian must sign this form with their respective
residence address and residence telephone number in order for their information to be published in the directory, whether they reside in the same or separate households.
Student�s
Name:____________________________________________________________________________________
|
(last) |
(first) |
(middle initial) |
Parent(s) or Guardian�s
Name(s):________________________________________________________________________
Student�s
Address:__________________________________________________________________________________
|
(street) |
(city/state) |
(zip code) |
Student�s Grade:___________________ Student�s Team (Middle
School)______________________
Residence telephone number:___________________
Parent/Guardian
Signature:___________________________________________________