Online Authorization to Release Records Form

Online Authorization to Release Student Records

First and Last Name of Student 

Date of Birth 

Grade Level  

SCHOOL FROM WHOM RECORDS ARE BEING REQUESTED

School 

Street 

City 

State 

Zip Code 

SCHOOL TO WHOM RECORDS ARE TO BE SENT:

The Lutheran High School of Kansas City

12411 Wornall Road

Kansas City, MO 64145

RECORDS REQUESTED:

  • School Cumulative Records
  • Health Records Including Immunizations
  • Current Report Card and/or Withdrawal Grades
  • Standardized Test Results
  • Discipline and Attendance Records
  • Verification Student Has Passed the U.S. Constitution Test and/or the Missouri COnstitution Test

Other 

Parent/Guardian First and Last Name 

To give permission to request school records, please enter initials 

Date 

 

 



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