Safe School Violation Disclosure

Form for disclosing safe school violations during the registration process.

Violation Information*

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

Name, position, and contact information of school official handling the violation(s), if known.
Details, comments, or explanation for any violations listed above.
If you have any documents to support the information, please upload them here, or give them to an OPA Principal.
Parent or Guardian Name*
First Last
Parent or Guardian phone number*
Parent or Guardian email
Required if you would like to receive a copy of this form.
Parent or Guardian Signature*
By signing, you are affirming that the information contained herein is accurate to the best of your knowledge.