Sex Education Opt-Out Form

Parental Statement of Conflict with Conscience

Curriculum Opt-Out Form
In accordance with N.J.S. § 18A:35-4.7, I believe that any part of the instructions in health, family life education or sex education is in conflict with his conscience, or sincerely held moral or religious beliefs shall be excused from that portion of the course where such instruction is being given and no penalties as to credit or graduation shall result therefrom. This statement will serve as written notice that I have chosen to opt my student out of the section below.
In accordance with the statement above, do you wish to opt your student out of the sex education sections of the curriculum?*

YesNo
Student Information
Student Name*

First NameLast Name
Student ID Number*
Student ID Number is located on your student's progress report, report card or bus pass.
School Name*
Parent/Guardian Information
Name*

First NameLast Name
Email*
We will use to send you a copy of the Opt-Out Request
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number. We may use this to verify the request.
I, First Name* Last Name* , in accordance with N.J.S. § 18A:35-4.7, have chosen to opt-out my student from the sex education curriculum.
Signature of Parent/Guardian*

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Parental Statement of Conflict with Conscience