Policies » Section I: Instruction » IHAM-R: Health Education And Exemption: Opt-Out Form

Policy Date: 01/02/2018

HSD File: IHAM-R
HEALTH AND SEX EDUCATION EXEMPTION EXEMPTION/OBJECTIONABLE COURSE MATERIAL: OPT-OUT FORM

I, ________________________ (parent/guardian) request that my child, __________________
be excused from participating in certain units of health or sex education instruction or that I object to the course material described below.

I, _________________ (parent/guardian) request that my child, ________________ be excused from participating in certain units of health or sex education instruction or that I object to the course material described below.

I request that the District waive the class attendance of my child in a class or courses on:
[ ] Comprehensive sex education, including in grades 6-12, instruction on the prevention, transmission, and spread of AIDS.
[ ] Family life instruction, including in grades 6-12, instruction on the prevention,

transmission, and spread of AIDS.
[ ] Instruction on diseases.
[ ] Recognizing and avoiding sexual abuse.
[ ] Instruction on donor programs for organ/tissue, blood donor, and transplantation.

Please identify the grade level, class, and building. ___________________________________
_____________________________________________________________________________

or

I object to this course material being used for my child’s education: (describe the specific course material in detail):
___________________________________________________________________

I understand that I am requesting the school to excuse my child from certain units of curriculum or specific course materials that are required by state law. I further understand that in lieu of receiving instruction in this unit of health education, my child may be required to receive alternative learning in health education that is sufficient to enable my child to meet state requirements for health education. I understand that I may be responsible for the additional costs of the alternative course material. I further understand that this opt-out exemption is only valid for the school year in which it is signed and subsequent waivers may be necessary. See RSA 186:11, IX-e (as amended in 2017).

________________________________ __________________________________
Parent/Guardian Signature Administrator Signature

Date Received ______________

This form is exempt from disclosure under the Right-to-Know law, RSA Chapter 91-A, RSA 186:11, IX-e.

Adopted: February 3, 2009
Revised: January 2, 2018