Pesticide Notification

  • As part of the Bolivar-Richburg Central School District’s pest management program, pesticides are occasionally applied.  You have the right to be informed prior to any pesticide application made to the school grounds and buildings.  In certain emergencies, pesticides may be applied without prior notice, but you will be provided notice following any such application.  If you need prior notification, please complete the information below and submit to:

    Mr. Randy Harmon, Superintendent of Buildings & Grounds
    Bolivar-Richburg Central School
    100 School Street
    Bolivar, NY  14715

     

     

    Pesticides use Prior Notification Request

    (Please Print)

     

    Parent/Guardian Name:________________________________________________

    Child’s Name:_______________________________________________________

    Street Address:______________________________________________________

    City:_______________________________    ZIP Code:______________________

    Telephone Numbers:    Daytime_________________    Evening_______________ 

    Please Check One: 

    _____    I wish to be notified prior to a scheduled pesticide treatment inside of the

                  building.

    _____    I wish to be notified prior to a scheduled pesticide treatment on the grounds

                  of the school.

    _____    Both of the above.

    __________________________________________            ________________

    Signature                                                                                 Date