SEL PROGRAM - Assertion of Non-Consent


I, [PARENT NAME], as a parent and/or legal guardian of [STUDENT NAME], [GRADE], 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 in any [LOCAL SEL PROGRAM] at [SCHOOL NAME].  

For the avoidance of doubt, my child is not allowed or permitted to in any lessons or instruction in [LOCAL SEL PROGRAM]

Best Regards,



Required Signature
I deny the release of my/my child’s directory information as indicated above.
                (Parent, Guardian or Eligible Student)