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1. Student Information: Basic identifying information about the student including full name, date of birth, grade level, and student ID
2. Parent/Guardian Information: Contact details and legal status of the person authorizing the release
3. School Information: Details of the current school, including name, address, and relevant contact information
4. Information to be Released: Specific categories of information authorized for release (e.g., academic records, attendance, behavioral records)
5. Recipient Information: Details of the person(s) or organization(s) authorized to receive the information
6. Purpose of Release: Clear statement of why the information is being released and how it will be used
7. Duration of Authorization: Time period for which the authorization is valid
8. Rights and Revocation: Statement of rights to revoke authorization and any limitations
9. Signatures: Space for dated signatures of parent/guardian and school official
1. Special Education Records: Additional section when IEP or special education records are involved
2. Health Information Release: Specific section for release of health-related information kept by the school
3. Psychological Assessment Records: Section for release of any psychological or counseling records
4. Digital Records Access: Section specifying release of information in digital format or through electronic systems
5. Third Party Disclosure Limitations: Additional restrictions on further disclosure by the receiving party
6. Emergency Contact Release: Section for authorizing release of emergency contact information
7. Photography/Media Release: Optional section for release of visual/media content of the student
1. Schedule A - Types of Information: Detailed checklist of specific types of information that may be released
2. Schedule B - Authorized Recipients List: Extended list of authorized recipients if multiple parties are involved
3. Schedule C - Privacy Policy Summary: Summary of relevant privacy policies and procedures
4. Appendix 1 - Glossary: Definitions of technical terms and educational jargon used in the form
5. Appendix 2 - Relevant Legislation: Summary of applicable privacy and education laws
Education
Healthcare
Social Services
Child Protection Services
Legal Services
Government Administration
Special Education Services
Mental Health Services
Educational Technology
Research and Academia
Administration
Student Services
Records Management
Compliance
Privacy
Legal
Registration
Admissions
Special Education
Student Support Services
School Principal
Education Administrator
Privacy Officer
School Registrar
Guidance Counselor
Special Education Coordinator
School Secretary
Admissions Officer
Student Services Manager
Records Manager
Compliance Officer
School Board Administrator
Educational Program Director
School District Superintendent
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ұԾ’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; ұԾ’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it


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