Disclosure of Personal Relationships and Interactions between staff and students

Disclosure of Personal Relationships and Interactions between staff and students
INSTRUCTIONS:
- STAFF SHOULD COMPLETE THIS FORM IF THEY HAVE ANY FORM OF CONTACT WITH CURRENT STUDENTS OUTSIDE OF THE SCHOOL SETTING.
- SELECT THE RELEVANT LINE MANAGER FOR REVIEW.
- SUPERVISORS SHOULD REVIEW AND PROVIDE FEEDBACK AS REQUIRED.
- THIS FORM SHOULD BE COMPLETED FOR EVERY STUDENT WHERE THERE IS OUTSIDE OF SCHOOL CONTACT
STAFF INFORMATION:
STAFF'S FULL NAME:
POSITION:
STUDENT INFORMATION:

Type the Students details below*

STUDENT'S FULL NAME:
STUDENT'S GRADE/CLASS:
AGE:
DETAILS OF THE OUTSIDE RELATIONSHIP:
NATURE OF RELATIONSHIP:

FRIENDSHIP WITH PARENTSFRIENDSHIPMENTORSHIP
TEAMMATE (PROVIDE DETAILS):
OTHER (SPECIFY):
TYPE OF CONTACT:

IN-PERSON MEETINGSTEXT MESSAGESPHONE CALLSSOCIAL MEDIA INTERACTION
OTHER (SPECIFY):
FREQUENCY OF CONTACT:

REGULAROCCASIONALRARE
ADDITIONAL DETAILS:
LOCATIONS OF INTERACTION:

PUBLIC PLACESSTAFF'S RESIDENCE
OTHER (SPECIFY):
I, blanks THE UNDERSIGNED, ACKNOWLEDGE AND CONFIRM THAT I HAVE READ AND UNDERSTAND
THE SCHOOL'S POLICIES REGARDING STAFF-STUDENT RELATIONSHIPS. I CERTIFY THAT
THE INFORMATION PROVIDED IS ACCURATE TO THE BEST OF MY KNOWLEDGE.
STAFF'S SIGNATURE:

Clear
Date

DayMonthYear
Date
SELECT YOUR LINE MANAGER:

VENLO KRUIZESIMON TAYLORPRAVIN RAMDANY
These emails are used in the Flow of the form. DO NOT REMOVE. Only edit them if these positions are filled by another staff member or their emails change.
Venlo's Email
Simon's Email
Pravin's Email
Principal's Email
example@example.com
Deputy Principal's Email
example@example.com
Line Manager's Email
example@example.com
Should be Empty:

These emails are used in the Flow of the form. DO NOT REMOVE. Only edit them if these positions are filled by another staff member or their emails change.