Condom Opt Out Letter

Dear Parent or Guardian/Custodian of High School Student:

The Department of Education offers an HIV/AIDS prevention program as part of an ongoing comprehensive health education program. In addition, all high school students in grades 9-12 are permitted to request free condoms at their school. As a parent or guardian, you may ask the school not to give your child condoms. This is referred to as a parent opt-out. You are not permitted to make this request if your child: 1) is 18 years of age or older; 2) has been or is currently married; 3) is a parent, and/or 4) is entitled under law to give consent for himself/herself.

To request that your daughter/son not be permitted to receive condoms at his/her high school, please complete the attached sheet and send it to the principal in an envelope marked “CONFIDENTIAL.” If you change your mind and decide that your youngster can request free condoms, send a letter to the principal during the school year.

We are committed to ensuring confidentiality to all students, including those who do not participate in this program. All high schools know this policy and have been told to maintain the confidentiality of students.

The condom availability program for high school students offers an opportunity for you to talk to your child about health issues associated with HIV/AIDS. The most responsible decision a young person can make in this regard is to abstain from any high risk behaviors, including sexual intercourse and substance abuse. Please support your child in making positive health choices.

Educationally Yours,

Mrs. Dubei

Sign and return only if you DO NOT want your daughter/son to participate in the Condom Availability component of the HIV/AIDS prevention program. It must be noted that this option shall not apply to students who are 18 years or older, who are or who have been married, who are parents, or who are entitled under law to give consent for themselves. If you have more than one child enrolled in Queens Collegiate, please complete a separate form for each child.

My son/daughter, _____________________________________________, who is in grade 9 at Queens Collegiate High School IS NOT to participate in the condom availability component of the program.

My daughter’s/son’s Public School Identification Number is : _____________________________. (If you do not know this number, the school will enter it for you.)

_______________________________________ _______________________________________

Printed name of parent/guardian/custodian Signature of parent/guardian/custodian



If your daughter/son is not to participate, return this portion to Mrs. Dubei in an envelope marked “CONFIDENTIAL.”

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