Parental+Consent+Form

**Topics of Human Sexuality Instruction **    As part of your child’s education, he/she has enrolled in a course that includes instruction on topics related to human sexuality. You are receiving this consent form because instruction and/or discussion of human sexuality topics are a possibility in this course. Please read the form carefully, select **one option**, sign, and return to the teacher identified above. Your student will not be allowed to participate in class activities without this completed and signed form on file. Thank you.  All instruction related to human sexuality and/or sexual activity will take place within the context of education and Program materials and guest speakers supporting instruction on these topics have been reviewed and approved by the local district review committee. Teachers may respond to spontaneous student questions for the purposes of providing accurate data or correcting inaccurate or misleading information or comments made by students in class regarding human sexuality.  þ  Contraception, including condoms*  *Topics about contraception and condoms may be presented as part of this course (only if the box above is checked).   _______I GRANT permission for my child to participate in the scheduled activities/discussions as described above. Option 2 //** _______I GRANT permission for my child to participate in the scheduled activities/discussions as described above, //with the exception of _____________________________________.// I understand that my child will receive an alternative assignment of equal value and will not attend the regularly scheduled class on the day of this instruction. My child will be provided a safe, supervised place within the school during the class period(s). It will be his/her responsibility to report to the pre-arranged location, check in with the teacher or supervisor, and submit the completed assignment to the appropriate person.  <span style="color: black; font-family: 'Times New Roman','serif';">_______Prior to making a decision, I will contact you at the school within the next two weeks to arrange a time to discuss the planned curriculum and/or review the materials. <span style="color: black; font-family: 'Times New Roman','serif';"> <span style="color: black; font-family: 'Times New Roman','serif';">_______I DENY permission for my child to participate in any of the scheduled activities/discussions as checked in the above box. I understand that while my child is not involved in the exempted portion of the curriculum, he/she will be provided a safe, supervised place within the school during the class periods and will receive an alternative assignment related to other elements of the course. I shall take responsibility, in cooperation with the teacher and the school, for the student learning the required course material identified on this form. <span style="color: black; font-family: 'Times New Roman','serif';"> <span style="color: black; font-family: 'Times New Roman','serif';"> **<span style="color: black; font-family: 'Times New Roman','serif';">PLEASE SIGN AND RETURN //ENTIRE// FORM TO TEACHER ** <span style="font-family: 'Times New Roman','serif'; font-size: 12pt;"> <span style="font-family: 'Times New Roman','serif'; font-size: 12pt;">I have read this form and have chosen **one option** from the preceding list. <span style="font-family: 'Times New Roman','serif'; font-size: 12pt;"> <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 115%;">
 * <span style="color: black; font-family: 'Times New Roman','serif'; font-size: 18pt;">Parent/Guardian Consent Form **
 * <span style="color: black; font-family: 'Times New Roman','serif';">Name of Student: __________________________________________ Class Period: _____ **
 * //<span style="color: black; font-family: 'Times New Roman','serif';">Parents must receive this form no later than two weeks prior to the beginning of instruction. //**
 * <span style="color: black; font-family: 'Times New Roman','serif';">Course: _______________ **
 * <span style="color: black; font-family: 'Times New Roman','serif';">School: **<span style="color: black; font-family: 'Times New Roman','serif';"> ________________________________________
 * <span style="color: black; font-family: 'Times New Roman','serif';">Dear Parent/Guardian: **
 * <span style="color: black; font-family: 'Times New Roman','serif';">INFORMATION **
 * __<span style="color: black; font-family: 'Times New Roman','serif';">*Please choose //one// option* __**
 * <span style="color: black; font-family: 'Times New Roman','serif';">DISCLOSURE: **
 * <span style="color: black; font-family: 'Times New Roman','serif';">The curriculum for this course includes instructions and/or discussions about the topics checked in this box: **<span style="color: black; font-family: 'Times New Roman','serif';">**Teacher Use Only**
 * <span style="color: black; font-family: 'Times New Roman','serif';">Name of Student: ____________________________________________________ **
 * <span style="color: black; font-family: 'Times New Roman','serif';">OPTIONS: //Please read and check only one of the following:// **
 * //<span style="color: black; font-family: 'Times New Roman','serif';">Option 1 //**
 * //<span style="color: black; font-family: 'Times New Roman','serif';">
 * //<span style="color: black; font-family: 'Times New Roman','serif';">Option 3 //**
 * //<span style="color: black; font-family: 'Times New Roman','serif';">Option 4 //**
 * //<span style="color: black; font-family: 'Times New Roman','serif';">This consent form may be sent to parents within 2 weeks after the beginning of the course, but not less than 2 weeks prior to instruction of the identified topics. Under state law, your child cannot participate in the scheduled instructional activity specified above unless and until this signed letter of permission is returned to the teacher identified on this form. Signed forms will be kept on file at the school for a minimum of one year. //**
 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt;">Parent/Guardian Signature: ****<span style="font-family: 'Times New Roman','serif'; font-size: 10pt;">_________________________________________________________ **
 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 115%;">Telephone Number: **<span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 115%;">___________________________ **Date:** ____________________