5145.511 Form 1

New Hartford Public Schools

New Hartford, Connecticut

Sexual Abuse Prevention and Education Program

   Student Program Opt-Out Form

Connecticut Law, Public Act 14-196, mandates that schools provide age-appropriate sexual abuse and assault awareness and prevention education in Kindergarten through Grade 12. The District will be utilizing instructional modules and developmentally appropriate educational material in each school and in all grades.

The age-appropriate lessons will include:

   Personal safety.  Students will learn important safety rules, such as safety with guns, sharp tools, and fire, and when riding on wheel cars (i.e. skate boards, bicycles) and in cars.  They will also learn ways to help them decide if something is safe or not.

   Touching Safely.  Students will learn about safe, unsafe, and unwanted touches, and rules about touching private body parts.  They'll also learn to say no to unsafe or unwanted touches, and to tell an adult if someone breaks rules about touching private body parts.

   Assertiveness.  These lessons will also include how to ask an adult for help, telling an adult about an unsafe situation and being assertive to get out of unsafe situations.

In addition, the instructions will include actions child victims may take to get help, intervention and counseling options for child victims, access to educational resources to help child victims succeed in school and uniform procedures for reporting instances for child sexual abuse and assault to school staff.

The law allows students to opt-out of the awareness program or any part of it if the student's parent or guardian so notifies the District in writing.

Please complete this form ONLY if you DO NOT want your child to participate in the sexual abuse awareness and prevention program that will be conducted by the New Hartford School District.

Child's Name: ________________________________________________________________________

Child's Grade: _________________  Child's Teacher: _________________________________________

I DO NOT want my child, named above, to participate in the sexual abuse awareness and prevention program that will be conducted by the ________________________ School District.

Parent/Guardian Name (Please Print): ______________________________________________________

Parent/Guardian Signature: ______________________________________________________________

Date: _______________________

This form must be received at school by ____________________________________________________

If a parent/guardian does not submit this opt-out form, the student will participate in the program.

Students who do not participate in this program will be provided opportunities for study and/or school work when the student would otherwise be participating in the program.