Complete this form if you do not wish your child’s contact information to be released to military recruiters without prior written parental consent.

The No Child Left Behind Act of 2001 requires that schools give parents and students an opportunity to request that information not be disclosed or released to military recruiters (including name, address, and telephone number).

Once a parent/guardian or student (over 18) makes this request, this information cannot be disclosed without written permission.

Although it is not required by law, it is recommended that both a parent/guardian and the student sign this form. It is also recommended that you keep a copy for your records.

A copy of the form may be acquired in the Counseling Center. This pertains only to students in the 11th & 12th grades.

My signature below is my official request of the principal of Ferndale High School that my child’s name, address, and telephone number not be released to military recruiters without my prior written consent.

__________________________________________

Today’s Date

_________________________________________________ _________________________________________________

Student’s Name– Print Student’s Signature

_________________________________________________ _________________________________________________

Print Name of Parent/Guardian Signature of Parent/Guardian

Note to Parents/Guardians: If you do not return this completed form, the Ferndale Schools Board of Education may release, without your prior written consent, your child’s name, address, and telephone number in accordance with Federal and State law. This authorizes recruiters from the United States Armed Forces to contact your child. This form only needs to be completed and returned if parents/guardians do not want the Board of Education to release information without their prior written consent.