Dear [PRINCIPAL], 

I, [PARENT NAME], as a parent and/or legal guardian of [STUDENT NAME], grade [GRADE LEVEL], a minor child, hereby exercise my right under the US. Constitution and laws of the State of Utah, to direct the upbringing and education of my minor child as follows:  

I DO NOT CONSENT to my child’s participation reading [NAME OF BOOK] at [NAME OF SCHOOL] in [TEACHER]’s [CLASSNAME] class or from the library.  

Furthermore, I DO NOT CONSENT to participation of discussion about the text, subtext, or selection “as a whole.”

Finally, I DO NOT CONSENT to the assessment of my child’s understanding of the text or its contents.

For the avoidance of doubt, my child is not allowed or permitted to engage with any book or in any lessons or instruction in sexual behavior or attitudes, sexual activity, sexual orientation; gender identity; or illegal, antisocial, self-incriminating or demeaning behavior.

Please place this notice in my child’s permanent file.  Should this text or book be present in the school library, please make a notation on my student’s file that they are restricted from access to view, read or engage with this text.  I do not consent to my child checking out this book.

Best Regards,

[PARENT NAME]
Dated: [DATE]