PARENT OPT OUT FORM

Date:__________________
To (School): _______________________________________________
(Principal/Assist. Principal)_____________________________________

I/We, parent(s)/guardian(s) of ________________________________, have chosen NOT to delegate our responsibility in the following areas of education or health to any teacher, administrator, guest speaker, medical practitioner or agent:

  1. Family planning or non-emergency health services, referrals or programs
  2. Sex education, family living, alternative lifestyles, or diversity
  3. AIDS or STD's
  4. "Decision Making" that is not directly related to academic studies
  5. Teenage Health Consultant Programs
  6. Homosexuality and/or Multiculturalism or Globalism
  7. Affective Education (feelings) or "values" training
  8. Population control or overpopulation (Large Family bias)
  9. Suicide, euthanasia, dying, or death
  10. Psychological self esteem, opinion, attitude, or value surveys
  11. Environmentalism that is biased or has New Age/One World/Globalism as an agenda association
  12. Drugs and alcohol abuse or prevention

Because I/we, as parent(s)/guardian(s) of ____________________________, provide for the above listed training, I/We:

  1. Request that he/she be sent to the library with an academic assignment each time that these topics are to be discussed in class
  2. Request to be notified weekly if our request(s) require more than one hour of alternative library study per week
  3. Request that there be no referral for any prevention, intervention or aftercare program or services of any organization or agency (whether internal or external), even if the law might allow treatment without parent/guardian consent
  4. Request that we be contacted prior to any disciplinary action or counseling
  5. Defer permission for all emotional wellness, psychological, guided imagery, health or other evaluations or screenings
  6. Do not authorize the use of his/her Social Security Number for any reason, and insist that it be removed from any documents on which the school and/or administration may have it listed (The Social Security Act, 42 USCS #405, page. 368, does not grant schools use authorization)
  7. Be contacted immediately with any academic, behavioral, or health concerns needing our attention

Thank you for your cooperation.
Most Respectfully,

________________________________ Parent/Guardian

________________________________ School Representative