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 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 / Guardian Date
_________________________________________ Name( Please print)