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Pesticide Application Notice

Printable Form


This Notice, required by Public Act 99-165, serves to issue a statement of policy regarding the application of pesticides at schools and on school grounds. This statement is required to be made annually to all staff and parents and guardians of students enrolled in schools under the control of the Vernon Board of Education.

The Vernon Public Schools has adopted an Integrated Pest Management policy for pest control within the buildings and grounds of the Vernon Public Schools. Pesticide products may be applied by schedule for preventative or residual control of insect, weed, and/or plant disease pests. Our IPM approach focuses on eliminating conditions that are favorable to pest infestation, thereby making their survival more difficult and reducing the need for pesticide applications.


Pesticide applications will not be performed within any building or on the grounds of any school during regular school hours or during planned activities unless an emergency application is necessary to eliminate an immediate threat to human health. These areas will be secured against access as necessary for the period specified by the manufacturer and taking into account all precautions found on the pesticide product label. All applications will be made by individuals holding valid State of CT certifications.


Parents, guardians and staff who would like to receive prior notice of pesticide applications may register to receive such notice by completing the form below and returning it directly to their child’s school. Registrants will be notified by mail so that notice may be received no later than twenty four hours prior to a pesticide application. Notification will include:


  • The name of the active ingredient of the pesticide being applied
  • The target pest
  • The location of the application on the school property
  • The date of the application
  • The name of the school administrator or their designee who may be contacted for further information


Registrants will be notified of any emergency pesticide applications that are made to eliminate an immediate threat to human health on or before the date of the application either verbally or in writing depending on the circumstances of the emergency application.

Prior year’s applications were for bees and wasps by A&A Pest Management, and poison ivy by Town of Vernon, Department of Parks and Recreation.

September 2016


Parent/Guardian:  Please complete a separate form for each student and return this form to your child’s school.




I would like to receive prior notice of pesticide application.


Name of Student___________________________  Name of Parent/Guardian_____________________


Parent/Guardian Signature_______________________________________  Date__________________


Address_______________________________________ City___________________  Zip____________


Home Phone Number________________________ Email Address______________________________