Request to Attend Event Form

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The safety of our faculty and staff is very important to the Renick R-V School District. The board
of education and administration work hard to ensure nothing happens to the members of our
educational community. However, the board and administration understand sometimes there
are circumstances which need to be addressed in order for specific students to have the
parental support which research shows is most important in a child’s education.

Complete this form with as much information as possible. Attach all documents directly to the
form and return it to the Superintendent of Schools no later than five days prior to the event.
Each request will be taken into consideration using the knowledge from the information
provided, law enforcement and court documents.

Email *

Full Name of Person Seeking Event Permission: *

Phone Number: *

Today's Date: *

YYYY

Date of Last Offense: *

YYYY

Name(s) of Student(s) of Interest: *

Grade(s): *

Event of Interest: *

Date of Event: *

YYYY

Is the child(ren) you are wishing to observe your biological child(ren)? *

Yes

If NO, how is this child related to you?

Is the child participating in the event or a spectator? *

Does the child reside in your home? *

Yes

If NO, where and with who does the child reside?

Was the child removed from your custody? *

Yes

Do you have court documents allowing you to have contact with the child? (If so, please submit a copy for the student's file if you have not already.) *

Yes

Are you in counseling for the offense? *

Yes

If YES, where?

May we speak to your counselor?

Yes

Clear selection

Counselor contact information: (Please let your counselor know the school district superintendent will be contacting them.)

Who is your parole officer?

Parole Officer contact number:

May we contact them? (Please inform them the school district superintendent will be contacting them.)

Yes

Clear selection

Are you taking any other self-help courses to ensure the prior offense will not be repeated? *

Yes

Please list the program and contact information.

Do you have a safety plan you can provide the district in case you get into a situation which might cause you to repeat your offense? (Provide the safety plan to the district prior to attending the event.) *

Yes

Do you have a state approved licensed supervisor that will attend the event with you? (Please attach a copy of the supervisor’s credentials to accompany you on the premises.) *

Yes

Is there any other information you would like to provide?

Submit

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