Request to Excuse Student from HIV Prevention Education

1.) I have attended a school district presentation of the HIV Prevention Education Program, &/or

2.) I have reviewed the HIV Prevention Education Program materials at my child(ren)’s school office, &/or

3.) I have accessed and reviewed the HIV Prevention Education Program materials on the school district’s website.

* 1. Name of child(ren) or legal ward(s)

* 2. Please list the schools your child(ren) attend.

* 3. Parent/Legal Guardian Name.

Terms of Agreement:
I object to the participation of my child(ren) or legal ward(s) in the HIV Prevention Education Program and request that he/she/they be excused from participation in the presentation.
I understand that the HIV epidemic presents a serious threat to the general population, particularly to youth, and I have received &/or have access to resources to present this information to my child(ren) at home.

* 4. I have read and agree to the listed terms above.

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