Parent Assurance Letter

Please complete the form below. Required fields marked with an asterisk *

Student's Name*

Answer Required

Date*

Answer Required

Student Grade*

Answer Required

TK/Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

8th Grade

Student Date of Birth*

Answer Required

Please check the box *

Answer Required

I declare that I am the parent/guardian/caregiver of the student named above, and I am withdrawing them from this school due to the reason below

Select reason(s) for disenrollment*

Answer Required

Enrolling in a private school (please name the school below)

Enrolling in another public school (please name the school and city below)

Moving to another city within State of California (please add city below)

Moving to another state (please specify state and city below)

Moving to another country (please specify country below)

Full-time private tutoring by a credentialed tutor

Other:

Please specify details from choice above*

Answer Required

I assure you that I will enroll this child in a school within a reasonable period of time. I am aware of compulsory education statue in California, as stated in Cal. Education Code Section 48200 that requires all children between the ages of 6-18 years old to have a full-time education, unless they are exempt. I also understand that if I fail to compel the attendance of the child in my care to attend a full-time education while in the State of California, unless they are exempt, that I may be subject to criminal penalities.

To the best of my knowledge, this child will be attending school in the city and state of:*

Answer Required

I declare under penalty of perjury under the laws of California that the above statements are true and correct

Signature*

Signature Required

New Address

Street Address

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Please fix the highlighted areas below before submitting.

Parent Assurance Letter