P3045-F-2
15510—1st Ave. NE/PO Box 519, Duvall, WA 98019 ● 425.844.4500 ● 425.844.4502 FAX
www.riverview.wednet.edu
Law Enforcement Contact School Documentation Form
RSD Procedure P3080-5:
Student interviews with a law enforcement official, without a warrant or court order and without exigent circumstances, requests to
interview the suspected abused or neglected student under twelve (12) years of age, the principal or designee shall contact the parent
and notify them of the request. Absent a warrant, court order or exigent circumstances, law enforcement officers must obtain parental
consent before the student will be made available for an interview. A child twelve (12) years of age or older may give consent. The
principal or designee shall document the consent questions asked and the answers given.
_______________________________________________________________________________
Date: _________________
Time: ________________
Name of Student: __________________________Grade: ____ Teacher: __________________
Law Enforcement Official: ____________________________________
Questions to Child:
Would you like a school person to be present when you speak to the Law Enforcement Official?
__ Yes __ No
Reply/Comments: _______________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Prior parent notification and consent was obtained by:
__ School Staff ____________________ Spoke to Whom: _________________________
When: _______________________________
__ Law Enforcement Officer
______________________________________________
Signature of Person Completing Form
CC: Student File
School Counselor
School Principal
______________________
Date