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:
- School records;
- Parent mailing;
- The police officer; and
- The witnessing administrator