Shot Record Request
If you have any questions, please contact North County High School student services office at 573-431-3300, extension 6, selection 2 or by fax at 573-534-0072.
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Last Name *
Maiden Name (if applicable)
First Name *
Date of Birth *
MM
/
DD
/
YYYY
Street Address *
City *
State *
Zip Code *
Phone Number *
Year of Graduation *
Last Year Attended NCHS
Please send my official shot record to:  (please include NAME and FULL ADDRESS of the person/school receiving this record) *
Optional:  Please email and/or fax my shot record to the following (if you prefer the record to be sent as both an email and fax, please include the recipient's email and fax number in the space below):
By typing my name below, I am acknowledging and certifying that I am the named individual above and approve of having my official shot record sent to the person/school designated. *
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