ENFIELD PUBLIC SCHOOLS
FORM E
Report of Teen Dating Violence / Consent to Release Student Information Date : ________________________________ Name of Student : ________________________________ School : ________________________________ To Parent / Guardian :
A report of teen dating violence has been made on behalf of your child alleging that he / she has been the victim of teen dating violence . In order to facilitate a prompt and thorough review of the report , the [__________________] Public Schools may wish to disclose the fact that this complaint has been filed in connection with its review .
( 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 review 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 review 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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