Form for disclosing safe school violations during the registration process.
  • For what grade is the student seeking enrollment?
  • Date Format: MM slash DD slash YYYY
  • List all incidents separately. Use the + at the end of the row to add another row if needed.
    Violation (choose from the dropdown menu)Date (month/year)Disciplinary Action Taken (or pending)Location (school)Name of Administrator 
  • Required if you would like to receive a copy of this form.
  • By signing, you are affirming that the information contained herein is accurate to the best of your knowledge.