Information for Parents_ Campbell PS
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Non-Consent Form <strong>for</strong> <strong>Parents</strong>/Guardians<br />
Speaking Out Survey<br />
• I have read and understood the in<strong>for</strong>mation about the survey, or have had it explained<br />
to me.<br />
• I understand that my child does not have to participate.<br />
• I have discussed this survey with my child.<br />
Non-Consent <strong>for</strong> my child to participate in the survey<br />
I do not give permission <strong>for</strong> my child to participate in the survey.<br />
Full name of child (printed): _________________________________________________<br />
Name of parent/guardian (printed): _____________________________________________<br />
Signature of parent/guardian: __________________________________________________<br />
Date: ______________________________________________________________________<br />
Please return this <strong>for</strong>m to the Administration Office at your child’s school.
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