Name of Parent: 

                 Address: 

                 Address: 

                 Phone: 

                 Names of children: 
 
  

                 Date: 
 
  

                 Name of school: 

                 Address: 
 
  

                 To Whom it May Concern: 

                 Pursuant to the fourth and ninth amendments to the 
                 Constitution of the united States: 

                 1) My children will not be allowed to be removed from their 
                     classroom(s) by any agent of the Government/DHS without a 
                     properly executed search warrant. 

                 2) My children will not be isolated in the presence of, or 
                     interrogated by, such agents without the presence of the 
                     parent’s representative and the children's legal representative. 

                 3) In the event that such agents present themselves on school 
                     property, and have shown proper government identification, 
                     and a legally executed search warrant, said children will not be 
                     removed from classroom(s) for the purpose of any form of 
                     questioning or interrogation prior to notification and presence of 
                     one or both parents, the parents’ representative and child's legal 
                     representative. 

                     I am, for the record, refusing to consent to any interview of or 
                     search of or physical examination of of my children, my home, 
                     or myself and I am refusing to waive any rights pertaining to 
                     myself or my children. If you ignore my excercise of these 
                     rights and attempt to procure a waiver, I wish to confer with my 
                     attorney prior to any conversation with law enforcement and/or 
                     child protection agency on the subject of waiver. Any action 
                     taken in violation of these instructions is prima facie evidence 
                     of bad faith and of an overt and wilful violation of my rights 
                     without my consent, and severs the responsible party/parties 
                     from any immunity protections provided for under the law 
                     based on the presumption of acts committed in good faith. 
                     These instructions remain in effect as long as my children are 
                     enrolled in this school or until rescinded in writing by me. 

                    Sincerely,