Acknowledgement of Annual Notice

ACKNOWLEDGEMENT OF PARENT OR GUARDIAN OF ANNUAL RIGHTS NOTIFICATION

Print, sign, and return this page to your child’s school indicating that you have been notified of the specified activities.

This annual notification is also available in an electronic format and can be provided to you upon request. If the notice is provided in an electronic format, the parent or guardian shall submit to the school this signed acknowledgement of receipt of the notice.

Student’s Name:_________________________________________________

School: __________________________________________Grade: ________

I hereby acknowledge receipt of information regarding my rights, responsibilities, and protections.

Signature of Parent or Guardian: ___________________________Date: _______________

Click here for a copy of the above form for signature