REQUEST FOR STUDENT RECORD

Embassy of Heaven Church

www.EmbassyOfHeaven.Org
Please type or print clearly using black ink:
School
Address
City, State, ZIP
_________________________________, a former student in the ______________ grade of your school has enrolled in the Embassy of Heaven Christian School. Please forward all records pertaining to this student to:

Student Records
Embassy of Heaven Christian School
PO Box 337
Stayton, Oregon 97383-0337

_________________________________
             Signature of Records Custodian

     I hereby give my permission for the records of the above-named student to be transmitted to the Embassy of Heaven Christian School.

_________________________________
Signature of Parent or Guardian

_________________________________
Date

Use your browser to print this form. Fill in the date, name and address of the school previously attended and your child's name and grade level. Sign and date as Parent or Guardian and mail with completed 'Student Enrollment Request' form to Embassy of Heaven; PO Box 337; Stayton, Oregon 97383-0337; Kingdom of Heaven.

Click here to return to main Student Body Card page