Sample Parent Permission Slip & Opt-Out Form For Sexual Health Curriculum

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Parent Permission
Parent permission must be obtained before any survey data is collected or before
any exposure to the Worth the Wait / Wellness & Sexual Health curriculum. The
purpose of the permission slip is to make parents aware that a sex education
program will be taught in their child’s school and allows them the opportunity to
“opt-out” a child from the program if desired. It is recommended that an “active”
permission slip be used. Sample templates are provided below, but each school
should develop a form appropriate for their district. As stated on the permission
slip, we suggest that parents be required to come to the school to “opt-out” their
child. This gives school personnel the chance to discuss the program with
parents and address their concerns. To better ensure permission slips reach
their destination, schools may want to consider including them in the packet of
papers sent home at the beginning of each year requiring parent signatures.
SAMPLE PARENT PERMISSION SLIP & “OPT-OUT”
FORM
“Active” Parent Permission Slip Template:
Dear Parent/Guardian,
The ___________________________ Independent School District will soon begin teaching sexual health to all high school
students. School administrators have chosen Scott & White‘s abstinence curriculum called Worth the Wait / Wellness &
Sexual Health. It is a two-week unit based on the medical and legal facts regarding teen sexual activity and stresses
abstinence as the healthiest choice for teens. This curriculum does not address homosexuality or masturbation issues.
The curriculum will be available at each school campus for you to preview. You may call _________________________ at
____________________________ if you have any questions. Once you are familiar with the program, if you prefer that your
child not participate in this unit, please make an appointment to sign an ‘opt-out’ form.
I __________________________________ give my child __________________________________ permission to
participate in the Worth the Wait / Wellness & Sexual Health Sex Education curriculum. Please sign form below. Thank
you.
Sincerely,
__________________________________________
School Staff
Parent/Guardian Signature
Date
“Opt-Out” Template:
If you DO NOT wish your child to participate in the Worth the Wait / Wellness & Sexual Health curriculum, please complete
this form.
Following the review of the instructional materials on abstinence sex education, I am choosing to ‘opt-out’ my child,
_______________________________, from participating in the Worth the Wait / Wellness & Sexual Health curriculum. I
understand that he/she will not be allowed to remain in the classroom while the curriculum is being taught, and that he/she
will receive alternative lessons deemed appropriate by the school.
Child’s school: _______________________________________________________________ Grade__________________
Parent/Guardian Name (please print):_____________________________________________________________________
Signature: __________________________________________________________________ Date: __________________
Reason(s) for not participating:__________________________________________________________________________

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