Social/Family Relationship Exception Form

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**PLEASE READ THIS ENTIRE PARAGRAPH BEFORE SUBMITTING FORM**

This is a form to claim a social/family relationship exception to the Hutto ISD (HISD) Policy regarding electronic communication(s) between HISD employees and students.

Email *

Parent or legal guardian's name (Last, First) *

Phone Number (xxx-xxx-xxxx format) *

HISD employee you are allowing to freely communicate with your child(ren) (Last, First) *

Please type your child(ren)'s full legal name (Last, First) *

I have received and read a copy of the DH Local Policy. *

Yes

The HISD employee listed above has a social or family relationship with my child(ren) outside of school. *

Yes

I understand that communication between the named HISD employee and my child(ren) also named above would be exempt from the rules as stated in Board Policy DH (Local). *

Yes

I understand as the parent or guardian of the child(ren) listed, I am solely responsible for monitoring electronic communication between the HISD employee and my child(ren). *

Yes

Please select the campus/department the HISD employee reports to. If unknown please select 'Unknown'. *

Please type your name to verify the information you have entered is true and correct. This will serve as your electronic signature. *

A copy of your responses will be emailed to the address you provided.

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