Family Life and Human Sexuality and HIV/AIDS Prevention Permission Form

 

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Student Name

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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.

  1. Abstinence only. Student assigned this unit will receive information about sexual abstinence and no information about methods of contraception.

  2. Self-esteem, personal and family relationships, and environmental health. Students assigned this unit will receive no information about human sexuality.

  3. Independent study project. Students assigned this project will be required to select and complete an independant study project on a health-related topic.

 

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Parent Signature

 

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Date

 

(Please complete and return this form to school by _______________________________________________________)