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 )