Pesticide Application - Advance Notification by First Class Mail

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Dear Parent/ Guardian:

Complete this form ONLY if you are requesting advance notification of pesticide application by United States Postal Service first-class mail.

Please be advised that you WILL receive notice via the methods identified in the annual advisory notice and should only complete this form if you are also requesting notification by first-class mail.

If you are requesting prior notification of pesticide treatments conducted at this school or daycare center, other than a bait or gel formulation, and you would like the notice to be delivered by United States Postal Service firstclass mail, postmarked at least 3 days prior to the planned treatment, please complete the information on the following form and click Submit

Parent Name *

Student Name *

Street Address *

City, State, ZIP *

Day Phone Number *

Evening Phone Number *

Please stop sending me these notifications after the following School Year: *

Please Choose One: *

I wish to be notified prior to a scheduled pesticide application inside of the school building.

I wish to be notified prior to a scheduled pesticide application outside of the school building.

Both of the above.

Submit

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