6. No Assignment: Surrogate Parent agrees that this Agreement shall be a personal contract and shall not be assignable, in whole or in part, in any manner whatsoever.
7. Student Records: Surrogate Parent agrees to maintain all records of Student reviewed or maintained by Surrogate Parent in a confidential manner and agrees that, upon termination of this Agreement, all such records shall be returned to the Student’s district of residence.
< surrogate parent’s name here>
< surrogate parent’s signature here>
<date here>
Surrogate Parent (Print)
Surrogate Parent (Signature)
Date
<surrogate parent’s address here> <surrogate parent’s email address here> Address (Line 1) Email Address
<surrogate parent’s address here> <surrogate parent’s telephone number here> Address (Line 2) Telephone Number
<Sacramento County SELPA here> <Sacramento County SELPA signature> <date here> SELPA (Print) SELPA Representative (Signature) Date
Chapter 7 – Procedural Safeguards, Desert/Mountain SELPA
Page 98
As of 03/15/2013
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