Exhibit 1
APPLICATION FOR FIREARM/AMMUNITION ON SCHOOL GROUNDS
Please fill out all three sections of this application and attach all documents listed in Section 2. Incomplete applications will not be processed.
Return this application to:
Superintendent
Hart-Ransom Union School District
3920 Shoemake Avenue
Modesto, CA 95358
SECTION 1. Identifying Information
Name: Date of Birth:
Phone: Email:
School(s) at which I seek permission to carry a firearm and/or ammunition:
I am a (check one or more):
___ District employee (Job title: ___________________ Location: )
___ Parent/guardian of child(ren) at the following school(s):
___ Other:
Reason for requesting permission to carry firearm and/or ammunition on school grounds:
SECTION 2. Required Documents
The following documents must be attached to this application:
1. Copy of a valid Carry Concealed Weapon (CCW) license issued in California
Date of expiration: ______________________
2. Copy of current California Driver's License or other government-issued photo identification
SECTION 3. Acknowledgment
I understand that by submitting this application I am certifying under penalty of perjury under the laws of the State of California that the information provided is accurate and all documents attached are true and correct copies of the original. I understand that the decision to grant me permission to carry a firearm and/or ammunition on school grounds is at the sole discretion of the school district.
Print name: Date:
Signature:
Exhibit HART-RANSOM UNION SCHOOL DISTRICT
version: August 11, 2016 Modesto, California
Exhibit 2
3515.7
FIREARMS ON SCHOOL GROUNDS
FIREARM AND AMMUNITION POSSESSION AGREEMENT
The district permits the possession of firearms and ammunition on school grounds consistent with applicable law and Board policy. Before the Superintendent or designee grants such permission to any person to possess a firearm or ammunition on school grounds, the person requesting such permission must agree to the conditions described below regarding acceptable use and the safety restrictions imposed by the district.
I. Definitions
Ammunition means, but is not limited to, any bullet, cartridge, magazine, clip, speed loader, autoloader, or projectile capable of being fired from a firearm with a deadly consequence. Ammunition does not include blanks.
Firearm means a device, designed to be used as a weapon, from which is expelled through a barrel, a projectile by the force of an explosion or other form of combustion.
Carry Concealed Weapon (CCW) license means a valid, current permit to carry a concealed firearm issued by a county sheriff or chief of police within California and must contain no restriction on the carrying of a firearm on school grounds.
School grounds include, but are not limited to, school buildings, fields, storage areas, and parking lots.
II. District Rights
The Superintendent or designee shall notify the principal and other appropriate staff of all persons granted permission to carry a firearm and/or ammunition on school grounds.
Permission to carry a firearm and/or ammunition does not necessarily apply to all types of lawful firearms or ammunition. The Superintendent or designee may deny permission for any specific type of firearm or ammunition or otherwise change the scope of the permission.
The Superintendent or designee shall notify law enforcement in the event that the person uses a firearm or ammunition in a manner that threatens the safety of other persons or district property.
The district reserves the right to revoke, at any time, the permission granted to an individual to possess a firearm and/or ammunition on school grounds. Grounds for revocation include, but are not limited to, a violation of law, Board policy, or any terms of this Agreement; concerns of the Superintendent or designee about the individual's ability to safely use the firearm or ammunition on school grounds; or any subsequent change in Board policy that would prohibit the granting of permission to any individual.
III. Responsibilities
Responsibilities of any person given permission to carry a firearm or ammunition on school grounds include, but are not necessarily limited to:
1. Abiding by all applicable laws, Board policy, and the terms of this Agreement
2. Ensuring the safe storage and handling of the firearm and ammunition
3. Notifying the Superintendent or designee whenever the CCW license is revoked, expires, has new restrictions placed on it, or is renewed during the term of this Agreement and providing a copy of the renewed license as applicable
4. Only using the firearm and/or ammunition during an emergency that threatens the safety of students, staff, or other persons on school grounds and in accordance with applicable laws and the terms of the CCW license
IV. Acknowledgment of Receipt and Agreement
I acknowledge that I have received, read, and understood the Firearms and Ammunition
Possession Agreement. I understand that any violations of this Agreement may be grounds for revocation of the Agreement.
For district employees: In addition, I understand that any violations of this Agreement may result in disciplinary action, up to and including termination.
My signature below indicates my knowing and voluntary acceptance of all the terms of this Agreement. I understand it is my obligation to apply to renew this Agreement before it expires in order to continue to possess a firearm or ammunition on school grounds.
Print Name
Signature Date
VI. District Permission
Pursuant to Penal Code 626.9 and 30310 and as authorized by the Board of Trustees, I grant written permission to the following individual, whose name appears on the signature line under Section IV - Acknowledgement of Receipt and Agreement, to carry a firearm or ammunition on school grounds under the terms of this Agreement.
I reserve the right to revoke or modify the scope of the permission granted in this Agreement. This Agreement shall automatically expire on the date listed below and may be renewed subject to district criteria.
Name Title
Signature Date
Expiration date of Agreement: ______________________
Exhibit HART-RANSOM UNION SCHOOL DISTRICT
version: August 11, 2016 Modesto, California