Student Survey Opt-Out Form

I, [PARENT/LEGAL GUARDIAN  NAME], as a parent and/or legal guardian of [STUDENT NAME], a minor child, hereby exercise my right under the US. Constitution (20 U.S. Code § 1232h – Protection of pupil rights) and laws of the State of Maine, to direct the upbringing and education of my minor child as follows:  

I DO NOT CONSENT to my child’s participation in any opinion survey, personal analysis, evaluation, questionnaire or any other form of data collection that reveals or attempts to affect, or references or relates in any way to my child’s attitudes, habits, traits, opinions, beliefs or feelings concerning: curriculum, political affiliations, religious beliefs or practices; mental or psychological conditions; sexual behavior or attitudes, sexual activity, sexual orientation; gender identity; or illegal, antisocial, self-incriminating or demeaning behavior.

For the avoidance of doubt, my child is not allowed or permitted to partake in any survey, including curriculum centric and/or opinion in nature, without parental written consent.

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