RIVER VALE SCHOOL DISTRICT

                                                                             River Vale, New Jersey 07675

 

 

                                   Family Life Education Exclusionary Form

 

The purpose of this form is to insure compliance with the family life education requirements which indicate that procedures be established for any student whose parent or guardian presents to the school principal a signed statement that any part of the instruction in family life education is in conflict with his/her conscience or sincerely held moral or religious beliefs.  In such cases, the student will be excused from that portion of any course. [NJSA 18A:35-365 et seq.]

 

======================================================================

 

 

Date of Request ___________________________

 

Student’s Name ___________________________ School ____________________ Grade ______

 

 

                                                                             

I request that my child be excused from participating in the following portion(s) of the family life education program because it is in conflict with my conscience or sincerely held moral or religious beliefs.

 

Topic (be as specific as possible):

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Objections (list all that apply):

 

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

This form will be forwarded to the appropriate teacher.

 

________________________________________

Signature of Parent/Guardian

 

FRA:eef

7/21/03