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Student Record Release

Student record release

My child has withdrawn from your school. Please release his/her accumulative academic and health records to Canaan Christian Academy, 30 Hemlock Road, Lake Ariel, PA 18436. Phone number is 570-937-4848. Records can be faxed to 570-937-4800, emailed to [email protected], or mailed to the address above.

Contact Information

Student First Name*

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Student Last Name*

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Last school attended*

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Grade at time of withdrawal*

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Phone number of school*

Number Required

School Address

Street Address

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City

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Zip/Postal

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Signature*

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Confirmation Email

Confirmation Email *

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