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I, __________________ understand that while I am employed as an Employee of Sure Prep

Learning, I will become a mandated reporter under the Child Abuse and Neglect Reporting Act
(California Penal Code, Chapter 2.5, Section 11166). This means that I am required to report to
the county child abuse hotline number or local law enforcement agency immediately, or
whenever I have knowledge or reasonable suspicion that a child known to me in my professional
capacity or in my scope of employment may be abused or neglected. I understand that there is
no charge when calling the hotline number and that the hotline operates 24 hours per day, 7 days
per week, 365 days per year.

The following paragraph is required on this acknowledgment by Penal Code Section 11166.5:

Section 11166 of the Penal Code requires a child care custodian, health practitioner, fire fighter,
animal control officer, or humane society officer, employee of a child protective agency, or child
visitation monitor who has knowledge of, or observes, a child in his or her professional capacity
or within the scope of his or her employment when he or she knows or reasonably suspects has
been the victim of child abuse to report the known or suspected instance of child abuse to a child
protective agency immediately, or as soon as practically possible, by telephone and to prepare
and send a written report thereof within 36 hours of receiving the information concerning the

I affirm that I have read this statement and have knowledge and understanding of the reporting
requirements which apply to me as a mandated reporter under the California Child Abuse and
Neglect Reporting Act and agree to abide by it.

Signature of Employee