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Morgan Hill USD |  E  5141.4  Students

Child Abuse Prevention And Reporting   

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RELEASE AND ACCEPTANCE OF RESPONSIBILITY FOR

SCHOOL DISTRICT STUDENT

I am an officer with the (circle one): Morgan Hill Police Department / San Jose Police Department / Santa Clara County Sheriff's Department. I hereby accept responsibility for:

________________________________________________________ being released into my custody

(Name of student/child)

Morgan Hill Unified School District hereby releases the above named student/child into my care, custody and control. I am a law enforcement officer and neither the parent nor guardian of the student/child being released into my control.

The above-named student/child is being released into my care, custody, and control due to suspected and/or reported abuse of the student/child being released. It is my responsibility, and not the responsibility of Morgan Hill Unified School District, to notify the parents/guardians of the above named student that the District has released him/her into my care, custody, and control. Depending upon the facts surrounding the suspected child abuse investigation, I may or may not provide parents/guardians with the location of the student/child while in protective custody.

I, the undersigned, hereby swear under penalty of perjury that the above is true and correct.

I understand that the original remains with the school district and that I am entitled to a copy of this

document.

Officers name/badge no. (print):

Signed: Date:

Telephone Number:

Witnessed by: Date:

Exhibit MORGAN HILL UNIFIED SCHOOL DISTRICT

version: August 9, 2004 Morgan Hill, California

revised: May 1, 2006

revised: November 13, 2012