FORM D
ENFIELD PUBLIC SCHOOLS
Report of Bullying/Consent to Release Student Information
Date:
Name of Student:
________________________________
________________________________
School:
________________________________
To Parent/Guardian:
A report of bullying has been made on behalf of your child alleging that he/she has been the
victim of bullying. In order to facilitate a prompt and thorough investigation of the report, the Enfield
Public Schools may wish to disclose the fact that this complaint has been filed in connection with
investigation.
(Please check one):
_______ I hereby give permission for the Enfield Public Schools to disclose the fact that a
complaint concerning my child has been filed as part of its investigation of that complaint.
______ I do NOT give permission for the Enfield Public Schools to disclose the fact that a
complaint concerning my child has been filed as part of its investigation of that complaint.
_________________________________________
Signature of Parent/Guardian
Date
_________________________________________
Name (Please print)
Adopted: January 24, 2012
Revised: March 27, 2012
Revised: May 12, 2015
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