Please fill out this form, sign and:
Return to:
Highlands Middle School 1850 Plainfield Road LaGrange, IL 60525 | Highlands Elementary School 5850 Laurel Avenue LaGrange, IL 60525 |
I hereby request District 106 release my previous request to withhold student directory information which includes:
To process this request you must present this form along with photo identification to any school office or mail this form along with a copy of photo identification to the address listed above.
I have read this form carefully and understand the consequences of my decision to release my directory information. I understand:
Today's Date: _____________________________________
Student Name: _____________________________________
Parent/Guardian Name: _____________________________________
Parent/Guardian Email: _____________________________________
Please review your entries on this form. If all of the information is entered correctly please sign and submit the form to the address at the top of the form.
Signature: _____________________________________ Date: ___________________
Office Use Only
Received By: ____________________________________ Date Received: ___________________
Revised 2/20/2018