Possible template to retaining parent rights including policy and procedures. To be used with students who are not cognitively able to sign for their own rights and follow through with them.
Subject: DATE Retaining Parent Rights, Policy and Procedures
involving Child’s Name
Hand Delivered to ___________________ School on DATE in
to school personnel addressed herein below located at _______________ ,
This correspondence will become part of Child’s Name Permanent, Performance, Current, Supplemental and Medical School (If there is a behavior focus include “Behavior”) Files/Records with Name Public
School System and ____________ Elementary School until the year 2025.
TO: Mrs. ______________, ____________ Elementary School Principal
Mrs. ______________, ____________ Elementary School Assistant Principal
Mrs. _____________, Teacher
Mrs. _____________, Coordinator
This correspondence will become part of Child’s Name Current, Permanent,
Performance, Medical and Supplemental School Records and Files with
Name Public School System as well as Name Elementary School.
This request is applies to the following years 8-2011 to 12-31-2015 in regards
to minor Child’s Name:
1. We as mother, father and natural parents retain our parent rights of Child’s Name.
We Do Not Grant nor Give Permission to any Principal, Assistant Principal
including any employee of Name Public Schools permission to Waiver
our Parent Rights by acting in any role as said parent, guardian, legal guardian of
Child’s Name for any reasons unknown or unknown.
2. If any unknown or known situations, encounters, concerns, violations
should take place within any of the local school systems (Elementary, Middle
School, High School) located within Name Public School System
the following remains in place and no other document will supcede this one year
or years addressed herein.
Consent and Authorization is Revoked to ALL personnel employed with Name including Name School Resource Officers (SRO’s) ALL are not allowed to:
– Speak to our child Child’s Name without us being present or her attorney
if said concerns should arise or statements need to be made.
– Permission is denied in having Child’s Name sign any forms including
statements pertaining to anything inclusive of said school policies and procedures.
– Child’s Name does not have permission to make any verbal statement
– Demonstrate any situation – unknown or known
– Provide a Witness Statement (verbally nor written signed by her (Child’s Name)
– Child’s Name cannot be Video, No Role Playing is allowed and No Recorded
Statements can be obtained from her.
Parents Name and Child’s Name Attorney ____________
Phone Numbers must be called within 15 minutes of any incident,
situation, injury, any and all areas of concerns and importance; Child’s Name
will remain at her school in the principals or vice principals office until
her parents and/or her attorney arrives; her parents and her attorney will be
allowed 2 hours to arrive at her school; Any and All questions, interrogations,
statements (verbal, written, video) role playing, concerns and investigations
involving our child Child’s Name will only be conducted in the presence
of her parents and/or her attorney from Beginning School Date to End School Date for Graduation while she attends Name Public Schools System inclusive of Name Elementary School.
Name Public Schools Student/Parent Handbooks/Communications
3. Child’s Name is a minor, she is under age 18 years old; she cannot read and her level of understanding involving areas in Name Student Handbook inclusive of said statements associated with any Student Handbook, Classroom Rules, Student Conduct Behavior Codes as well as Picture boards addressing Rules, Regulations and Procedures, Selections from State Code of Laws Policies and Procedures and etc….
CANNOT BE SIGNED nor ACKNOWLEDGED at any point and time by
Child’s Name until the year Graduation Date.
All Correspondences must and will only be signed by her parents
Thank you for your understanding and continued support.