Brunswick City Schools - Student Withdrawal Form

For use when student is leaving Brunswick City School District.
School fees must be paid in full and all books returned prior to releasing any student records to a new school.

Date Date / MM / DD YYYY
Student Name Student Name First Last
Student Date of Birth Student Date of Birth / MM / DD YYYY
Brunswick School Most Recently Attended
Current Grade
New Home Address New Home Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent Phone: Parent Phone: - ### - ### ####
Name of New School Student Will Attend
Name of New School District Student Will Attend
New School/District Address New School/District Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Last Day of Attendance at BCSD School
Last Day of Attendance at BCSD School
/ MM / DD YYYY
Additional Information
Parent Email
By typing your name below it serves as an electronic signature.
Student Signature if 18 or older. By typing your name below it serves as an electronic signature.
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Attach Files
Phone Phone - ### - ### ####
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