Policy 3545F1 - Student Arrest Form

 Student Arrest Form

 Form for Signature of Arresting Officer

 I, ______________________________________, a duly sworn peace officer and member of the __________________________________________ Department, ________________________, have asked that ______________________________________, a student in the ____________________________________________________ RISE Charter School, be surrendered to me, and pursuant thereto have taken said student into my custody and am assuming full responsibility for the student’s arrest.

Date: __________________              Signature: _________________________________________

Time: __________________              Badge Number: _____________________________________

School Action

Date and time parents notified. If more than one attempt is made, include such information here:

_____________________________________________________________________________________________________________________________________________

 _________________________________________

            Signature of Administrator
 

One copy each shall be made for:

1. School records;
2. Parent mailing;
3. The police officer; and
4. The witnessing administrator