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PARENT ACKNOWLEDGMENT FORM Opt-Out of Archdiocesan Personal Safety Lessons (PSL)

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Complete this form to Opt-Out of Archdiocesan Personal Safety Lessons (PSL) 2024 for Grades K-8.

I would like to opt-out my child/children from participating in the personal safety program at

St. Croix Catholic School Stillwater

(Parish/School Name) (City)

List the name and grade of each child you wish to excuse.

1. Child's Name*

Answer Required

2. Child's Name

Answer Required

3. Child's Name

Answer Required

4. Child's Name

Answer Required

5. Child's Name

Answer Required

We will provide you with Personal Safety material to use if you wish when you discuss personal safety with your child(ren). We hope you will find this material helpful. The materials are posted at www.stcroixcatholic.org>Parents>SCCS Communications and under the section Archdiocesan Personal Safety Lessons (PSL). Please contact Angela Statz at [email protected] if you have any questions navigating to the materials.

Parent / Guardian's Name*

Answer Required

Signature*

Signature Required

Confirmation Email

Confirmation Email *

Email Required