[Address of School]
Dear Principal ___________:
I am the parent [or guardian] of __________________ [name(s) of student(s)], who attend(s) __________________ School in the ____ grade[s]. It is my understanding that, starting July 1, 2001, a new state law will require every school to maintain a list of parents who wish to receive advance notice of pesticide applications at the school their child attends. Each time pesticides are scheduled to be applied at the school, parents on the list must be provided with a written notice at least 48 hours in advance specifying the specific date and location of the application, the name and EPA registration number of the product being applied, the name and number of a person at the school who can be contacted to discuss the precautions being taken to protect children from exposure, and telephone numbers of information services that can provide specific information about the pesticides being applied.
Please consider this my formal request to be placed on the list to receive those notices and information. If the notices are to be mailed, please mail them to me at the following address:
I can be reached by telephone at the following numbers:
Signature of parent or guardian