504 Revocation of Consent

Type the name of the parent or guardian in the box.  Type the date you are providing the form to parents in the Date box.

This form should be completed by the parent and then transferred over into SRS with their responses (yes or no).  When you put the parent’s name and date at the top and hit save, it will load into the printed form to give to the parents to complete.  You will also want the parents to sign the form.

There is a second page to this form where you can upload any files necessary.  An example is you might want to download and attach the pen to paper form the parent marked on as evidence of their responses.

Below is a screen shot of what the form looks like in print form.  This form is what the parents will write on - indicating yes or no in the blanks, signing and dating the form at the bottom.