Sex Education Form

Date of Planned Instruction: 1
Name of Student: 2
Course: Teacher: Amy Robinson
School: Telephone Number: 3

Option 2. I grant permission for my child to participate in the discussions as described above, with the exception of the item(s) listed below. 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. I understand my child will be provided a safe, supervised place within the school during this class. 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.

Please write your exceptions below:

Parent/Guardian Signature

Name of Parent/Guardian signing this form

First NameLast Name