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Appendix D


Sample Form
(Parental Excuse From HIV/AIDS Instruction)

Request for parental excuse from HIV/AIDS Education

Please complete and sign this form if you wish that your child be excused from HIV/AIDS instruction. Completed forms should be returned to the teacher of the oldest child in the list below.

I have read the information provided in the Letter to parents regarding HIV/AIDS education at the elementary level. I wish to request that my child (children) be excused from classes when this topic is addressed.

Name of children
_______________________________
_______________________________
_______________________________

Grade
_______________________________
_______________________________
_______________________________



Date:______________________________________

Signature of Parent or Guardian:_____________________________________

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