904.3E1 Sex Offender Registrant Request Form

Sex Offender Registrant Request Form Registrants whose request is granted shall keep a copy of this completed form with them each time they come onto school grounds. This form shall be used to document the Principal’s response to an individual’s, on the Sex Offender Registry (SOR) (hereinafter “registrant”) request to come onto school grounds. [Requests will be considered only from registrants who are the parent/legal guardian of a student or the person designated by the parent/legal guardian to have access to the student.] To be Completed by Registrant Full Name _________________________________ Phone Number__________________________ (first, middle, last) Address _____________________________________ Email Address_________________________ Requested Visit Date _______________ Building or location to be visited¬__________________ _ Reason for request (check at least one):  Confer with school staff concerning my child’s academic, disciplinary or placement, including matters required by federal or state law.  Attend a school activity [in which my child is participating.] (activity name)  Attend a nonschool sponsored activity which is (activity name) _________________________ Registrant recognizes that permission to be on school grounds is at the discretion of the principal, or designee. Permission is granted for the sole reason, time, location, etc. listed below. Registrant recognizes that he/she is not permitted to be in any location, including restrooms, other than that listed below. Signature ________________________________ Date ____________ PRINCIPAL’S RESPONSE  Registrant is required to provide additional information as follows:  Registrant must follow check-in and check-out requirements as follows:  Registrant must be directly supervised while on school grounds by the following individual(s) designated by the Principal:  Registrant is restricted to the following designated location(s) on schools grounds:  Registrant may only be on school grounds during the following time period:  Request by registrant to be on school grounds is denied. Principal’s Signature ___________________________________Date ______________________ The completed form shall be kept on file at school. A copy of this completed form shall be provided to the registrant. 

 

Approved October 12, 2009 Reviewed February 8, 2021 Revised