SMITHS FALLS DISTRICT COLLEGIATE INSTITUTE

299 Percy Street

Smiths Falls, Ontario
K7A 5M2

RELEASE OF INFORMATION
I give SFDCI permission to speak to the Guidance/Administration at
the previous school(s) of __________________________.
(student name)
Name of last school: ______________________________________
Address of last school: ____________________________________
Name of previous school: __________________________________
Address of previous school: _________________________________

_______________________________
Signature (Parent if under 18)

________________
Date

-----------------------------------------------------------------------------------______________________________ is currently not under expulsion

Student name
or suspension from any school in the province of Ontario.

_______________________________
Signature (Parent if under 18)

________________
Date