Morgan Hill USD | E 5141.4 Students
Child Abuse Prevention And Reporting
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
Officers name/badge no. (print):
Witnessed by: Date:
Exhibit MORGAN HILL UNIFIED SCHOOL DISTRICT
version: August 9, 2004 Morgan Hill, California
revised: May 1, 2006
revised: November 13, 2012