ENFIELD PUBLIC SCHOOLS
FORM D
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 this
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/
_________________________________________
Name (Please print)
_________________________________
Guardian
Date