Variety Care Teen Clinic Form

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Dear Parent/Guardian:

In compliance with the Oklahoma Statute 70-11-105.1, schools are required to obtain permission from the parent/guardian of students who attend a class where instruction may include topics about the human reproductive system, contraception and related communicable diseases. Your student's class will include discussion and instruction about the human reproductive system, communicable diseases including HIV/AIDS, methods of contraception and sexual responsibility. A survey may be given during the course to evaluate what students learn. No grades will be assigned.

It is also required that the school provide parents/guardians the opportunity to inspect instruction materials related to the human reproductive system, related communicable diseases, methods of contraception and sexual responsibility. If you desire to review these materials, please contact Kali Parks at kparks@varietycare.org or 405-632-6688 ext. 11766.

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Please choose one option to continue:* This field is required.

Yes, I permit my student to attend the sex education course.

No, I DO NOT permit my student to attend the sex education course.

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Student Information* This field is required.

Student's full name

Student ID Number

Grade

What school will/does your child attend?

I am a...

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Parent/Guardian Information* This field is required.

Parent / Guardian's full name

Relation to Student

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Signature of Parent/Guardian* This field is required.

Clear