Family Life and Human Sexuality and HIV/AIDS Prevention
Permission Form
____________________________________
Student Name |
____________________________________
Daytime Phone Number of Parent/Guardian |
Please check YES or NO for each of the two questions
below.
I give permission for my student to receive instruction
on human sexuality. YES_____
NO_____
I give permission for my student to receive instruction
on sexually transmitted YES_____
NO_____
diseases, including HIV/AIDS.
If you did not give permission for either of the above
units, please circle the title of one of the alternative units of
instruction listed below that you would like your student to be assigned
as independant study.
- Abstinence only. Student assigned this unit will receive
information about sexual abstinence and no information about methods
of contraception.
- Self-esteem, personal and family relationships, and environmental
health. Students assigned this unit will receive no information
about human sexuality.
- Independent study project. Students assigned this project
will be required to select and complete an independant study project
on a health-related topic.
________________________________________________
Parent Signature
________________________________________________
Date
(Please complete and return this form to school by
_______________________________________________________)
