KIB- E ACCESS TO SCHOOL
PROPERTY BY SEX OFFENDERS This form is to be completed each time access is requested and is limited to that specific occurrence unless otherwise noted below, and must be submitted three (3) school days in advance to the applicable building Principal or Superintendent.
Name___________________________________ Date of Request________________________ Date of Birth (Month/Day/Year)________________ Gender (circle one) Male Female Home Address _________________________________________________________________ Phone Numbers_________________________________________________________________ Home Cell Work E-mail address ________________________________________________________ Date(s) Requesting to be on School Property_____________________________________________ Time of Day Requesting to be on School Property_________________________________________ Name of School/Building or Location on School Campus________________________________ ______________________________________________________________________________________
Access shall be limited to the building and/or location noted herein, the parking lot and sidewalk/public access to the building or location designated herein.
State the specific reason/nature of the request to come upon school property_______________ _____________________________________________________________________________________ * * * * * If request is related to your employment, provide the following information: Current Employer __________________________________________________________________ Years Employed ___________ Name of Immediate Supervisor _________________________ Supervisor’s Phone Numbers _________________________________________________________ Work Cell
Applicant may NOT come on school property until applicant has received this form indicating approved by the Superintendent and access shall be limited as indicated below.
Signature below indicates the information provided herein is true and accurate and requesting party is in full compliance with all Wyoming statutes regarding registered sex offenders.
___________________________________________ _______________________________ Signature Date **SCHOOL USE ONLY** Form Submitted to: Principal/Superintendent Name____________________________ Building________________ Date Form Received ____________________________________ Limitations/Expectations for Access_________________________________________________ ______________________________________________________________________________ This request is ___ Approved ____ Denied
______________________________________ ____________________________ Superintendent Signature Date Revised 8/28/12 |
Policies > K_COMMUNITY >