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Pesticide Notification
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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 14715Pesticides 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