ANNUAL PARENT NOTICE 2013-2014 (FORM A) AMMENDMENTS AND OPT-OUT REGARDING PUPIL: ______________________________________

PART II - REQUEST TO DENY ACCESS TO DIRECTORY INFORMATION - COMPLETION IS OPTIONAL

If you DO NOT WISH directory information to be released regarding this pupil, please sign below. Otherwise, leave this portion blank. NOTE: signing this form will prohibit the District from providing your pupils name and other information to the news media, interested schools, parent-teacher associations, interested employers, and similar parties.

DO NOT RELEASE DIRECTORY INFORMATION FOR: Pupil Name_______________________________________ Date of Birth________________

Last Name First Name M.I.

___________________________________________________
Signature of Parent/Guardian or of pupil if age 18 or older

___________________
Date

(See Amendments below)

Form A Part 2 Amendments: We do not want our childs directory information provided to any outside and/or third party source (ie. News Media, Interested Schools, PTA, Employers, and Similar Parties) outside that of (Your School District). With that said, we do grant access for such things as: 1. The School Yearbook 2. Local School Play Directory/Programs 3. Videos being taken by other parents *Any Directory Information request (or when in doubt) outside of the above mentioned must be approved in writing by ___________________________.
Education Code 51938.

Comprehensive Sexual Health Education Opt Out Form

Pupil Name __________________________________ Grade ______ School ________________________________ As the parent/guardian of this pupil, I have read the Sexual Health and HIV/AIDS Prevention Instruction I do not give my permission for my child to participate in this in any way what so ever. I request that I be notified at lease 2 days prior to this training so that I have the opportunity to collaborate with the teacher as to what activity my child will be doing during the Sexual Health and HIV/AIDS training. Signature of Parent/Guardian _____________________________Date _________________

9/13/2013

Education Code 51513; 51938; 51939.

Tests, Questionnaires, Surveys, Examinations on Personal Beliefs or Practices Opt Out Form
Pupil Name __________________________________ Grade ______ School ________________________________ As the parent/guardian of this pupil, I have read the Tests, Questionnaires, Surveys, Examinations on Personal Beliefs or Practices: I do not give permission for my child to participate in this in any way what so ever. I request that I be notified at lease 2 days prior to this training so that I have the opportunity to collaborate with the teacher as to what activity my child will be doing during the associated training. Signature of Parent/Guardian _____________________________Date _________________

Education Code 32390, 48980(f), 46010.1, 49450 49455, 51101(a)(13) PUPIL HEALTH, SAFETY AND MEDICAL TREATMENT

Opt Out Form

Pupil Name __________________________________ Grade ______ School ________________________________ As the parent/guardian of this pupil, I have read the PUPIL HEALTH, SAFETY AND MEDICAL TREATMENT Agreement. 1. Fingerprint Policy: I do not give permission for my child to be fingerprinted, Iris scanned or any other personally identifiable methods without my prior written consent. 2. Confidential Medical Services: I do not give permission for my child to be excused from school by school authorities for the purpose of obtaining confidential medical services. 3. Physical Examination: I do not give permission for my child to be given a Physical Examination of any kind including, but not limited to: hearing, vision, or scoliosis screenings, etc. This does not apply in the event of a medical emergency as described in the Emergency Medical treatment form. 4. Psychological Testing Policy: I do not give permission for my child to be given Psychological Testing of any kind. Signature of Parent/Guardian _____________________________Date _________________

9/13/2013

PUPIL RECORDS

Opt Out Form

Pupil Name __________________________________ Grade ______ School ________________________________ As the parent/guardian of this pupil, I have read the Pupil Records Disclosure Agreement. Ref: Model Notification of Rights Under the Protection of Pupil Rights Amendment (PPRA): 1. I do not give permission for my child to complete any surveys or other data gathering methods for the following listed categories that might be required by or funded in part or whole California Ed Code, US Department of Education, or any private or other government agency without my expressed written consent.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Political affiliations or beliefs of the pupil or pupil's parent; Mental or psychological problems of the pupil or pupil's family; Sex behavior or attitudes; Illegal, anti-social, self-incriminating, or demeaning behavior; Critical appraisals of others with whom respondents have close family relationships; Legally recognized privileged relationships, such as with lawyers, doctors, or ministers; Religious practices, affiliations, or beliefs of the pupil or parents; or Income, other than as required by law to determine program eligibility. Any other survey, regardless of funding. Any non-emergency, invasive physical exam or screening required as a condition of attendance, administered by the school or its agent, and not necessary to protect the immediate health and safety of a pupil, including hearing, vision, or scoliosis screenings, or any physical exam or screening permitted or required under State law. 11. Activities involving collection, disclosure, or use of personal information obtained from pupils for marketing or to sell or otherwise distribute the information to others.

Signature of Parent/Guardian _____________________________Date _________________

Assessment Testing Opt Out

Pupil Name __________________________________ Grade ______ School ________________________________ As the parent/guardian of this pupil, I do not want my child to participate in any State, Federal or Private assessment testing including but not limited to STAR, or Smarter Balance Testing. Signature of Parent/Guardian _____________________________Date _________________

9/13/2013