Parental Permission Form – Reproductive Health & Safety 6th Grade
ISS’s health curriculum for the 6th grade will include topics from the Department of Public Instruction's
(DPI) "Healthful Living Standards", as well as topics from the Healthy Youth Act of 2009. The complete
bill and DPIs standards can be found at Departments/Curriculum and Instruction/PE and Health/
Resources for Parents. This information will be conveyed to students through the "Choosing the Best
Way" abstinence focused curriculum as well as through teacher-led lessons.
Information will be provided to students on the following topics:
6.ICR.2
Apply strategies
and skills for
developing and
maintaining
healthy
relationships.
6.ICR.3
Understand the
changes that occur
during puberty and
adolescence.
Understand the
risks and
prevention
strategies for
pregnancy,
STDs/HIV, and
sexual assault.
From the
Healthy Youth
Act of 2009 as
approved for 6th
grade by the ISS
BOE in 2009.
6.ICR.2.1 Explain the impact of early sexual activity outside of marriage on
physical, mental, emotional, and social health.
6.ICR.2.2 Summarize the responsibilities of parenthood.
6.ICR.2.3 Use effective refusal skills to avoid negative peer pressure,
sexual behaviors, and sexual harassment.
6.ICR.2.4 Use resources in the family, school, and community to report
sexual harassment and bullying.
6.ICR.2.5 Summarize strategies for predicting and avoiding conflict.
6.ICR.2.6 Design nonviolent solutions to conflicts based on an
understanding of the perspectives of those involved in the conflicts.
6.ICR2.7 Explain the signs of an abusive relationship and access resources
for help.
6.IR.3.1 Identify the challenges associated with the transitions in social
relationships that take place during puberty and adolescence.
6.ICR.3.2 Summarize the relationship between conception and the
menstrual cycle
How sexually transmitted diseases are and are not transmitted.
The effectiveness and safety of all federal Food and Drug Administration
(FDA)-approved methods of reducing the risk of contracting sexually
transmitted diseases,
The effectiveness and safety of all FDA-approved contraceptive methods
in preventing pregnancy.
Awareness of sexual assault, sexual abuse, and risk reduction.
Please read and complete the information requested below. If you do not want your child to take part in classes
on these topics, initial the appropriate box and return the form to the school as soon as possible. If you want your
child to participate you do not need to send this form back. If you have questions about the curriculum that your
child’s health teacher or principal cannot answer, contact Linda Rogers, Healthful Living Coordinator at (704) 8322550 or lwrogers@iss.k12.nc.us. Thank you.
I have read this form and understand the topics that will be covered during the Reproductive Health
and Safety classes.
Child’s name:____________________________________
(Please initial below.)
[
] My child may not take part in this instruction.
Parent/Guardian’s signature:______________________________________ Date:______________
Phone number:________________________________________
RETURN THIS FORM TO YOUR STUDENT'S PE/HEALTH TEACHER