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Parental Statement of Conflict with Conscience (opt-out) (K-4)

In accordance with N.J.S. § 18A:35-4.7, any child whose parent or guardian presents to the school principal a signed statement that any part of the instructions in health, family life education or sex education is in conflict with his conscience, or sincerely held moral or religious beliefs shall be excused from that portion of the course where such instruction is being given and no penalties as to credit or graduation shall result therefrom.

To ensure accurate record keeping, please note you will have to complete one form entry for each child.

All requests will be reviewed by building principals. Principals may seek further information from you to ensure we are properly implementing your wishes.

Please contact your Child's building principal with any questions.

Student Information

Student's First Name*

Answer required for "Student's First Name"

Student's Last Name*

Answer required for "Student's Last Name"

School Your Child Attends*

(Right now, this form is only for MBD and SRD. WTB form will be send out closer to the start of Trimester 2.)

Answer required for "School Your Child Attends"

Grade your child is in*

Answer required for "Grade your child is in"

Parent / Guardian Information

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Email Address*

Answer required for "Email Address"

Kindergarten Units of Study (Only complete if your child is in grade K)

We have identified the units of study for each grade level below and applicable standards. Please select the standard that you are opting your child out of.

Unit 1: Wellness & Nutrition (Please select the topics/ standard that you are opting your child out of)

Answer required for "Unit 1: Wellness & Nutrition (Please select the topics/ standard that you are opting your child out of)"

Explore how physical activity helps all humans stay healthy

Explore healthy eating habits

Explore self care techniques (wellness activities) related to emotional regulation.

Examine foods and the food groups

Unit 2 : Diseases, Hygiene & Healthy Living (Please select the topics/ standard that you are opting your child out of)

Answer required for "Unit 2 : Diseases, Hygiene & Healthy Living (Please select the topics/ standard that you are opting your child out of)"

Examine personal hygiene and its importance in healthy living.

Explore the concept of disease (germs at a Kindergarten level) and how proper hygiene and disease prevention tips can keep everyone healthy.

Identify school and community personnel who can address health emergencies.

Unit 3 : Safety & Preparedness (Please select the topics/ standard that you are opting your child out of)

Answer required for "Unit 3 : Safety & Preparedness (Please select the topics/ standard that you are opting your child out of)"

How to contact emergency services

What to do in case of emergency (fire, bus accident, car accident, etc.)

Explore the idea of staying staff on bikes, scooters, etc.

Explore the ideas of social emotional wellness and what to do if bullying/ unkind acts occur

Explore the idea of bodily autonomy and personal boundaries (at Kindergarten level)

1st Grade Units of Study (Only complete if your child is in grade 1)

We have identified the units of study for each grade level below and applicable standards. Please select the standard that you are opting your child out of.

Unit 1 : Personal Growth, Development & Nutrition (Please select the topics/ standard that you are opting your child out of)

Answer required for "Unit 1 : Personal Growth, Development & Nutrition (Please select the topics/ standard that you are opting your child out of)"

Define and demonstrate healthy choices and self-care practices in relation to wellness

Identify and locate body organs and body parts essential to life, everyday living, and related to healthy habits like washing hands, exercising, and eating well. (ie: brain, heart, lungs, eyes, ears, nose, mouth, arms, hands, legs, etc. This does not include private parts).

Sort foods according to food groups/sources and identify both healthy and unhealthy foods

Explain what information can be found on food and product labels.

Unit 2 : Interpersonal Communication, Decision Making & Goal Setting, Character Development (Please select the topics/ standard that you are opting your child out of)

Answer required for "Unit 2 : Interpersonal Communication, Decision Making & Goal Setting, Character Development (Please select the topics/ standard that you are opting your child out of)"

Learn how to communicate beliefs to others on topics the student feels are important (favorite color, pet, sports, activities, etc.)

Examine the idea that everyone makes mistakes and what happens when a mistake is made (growth mindset)

Introduce the idea of character traits (explore via literature examples, role models, etc.)

Explore the idea of peer pressure and how it can influence decision making (at grade 1 level)

Unit 3 : Diseases, Healthy Conditions & Social Emotional Health (Please select the topics/ standard that you are opting your child out of)

Answer required for "Unit 3 : Diseases, Healthy Conditions & Social Emotional Health (Please select the topics/ standard that you are opting your child out of)"

Identify to what extent can we keep ourselves disease free

Identify the difference between healthy and unhealthy risks (playground rules, sports rules, general household safety, bus safety )

Introduce the idea of character traits (explore via literature examples, role models, etc.)

Explore the idea of feelings (happiness, sadness, anger, etc.)

Unit 4 : Community Health Services, Medicines, Alcohol, Tobacco & Other Drugs (Please select the topics/ standard that you are opting your child out of)

Answer required for "Unit 4 : Community Health Services, Medicines, Alcohol, Tobacco & Other Drugs (Please select the topics/ standard that you are opting your child out of)"

Illustrate how community helpers and healthcare workers contribute to personal and community wellness

Identify different kinds of medicines and the rules for safe and appropriate use

Explain how medicines can be helpful and harmful, and that appropriate use can help keep people healthy

Define drugs and give examples of how drugs can be abused

Explore how tobacco use can impact the health and environment of both smoker and non-smoker

Unit 5 : Relationships, Differences & Similarities of Individuals (Please select the topics/ standard that you are opting your child out of)

Answer required for "Unit 5 : Relationships, Differences & Similarities of Individuals (Please select the topics/ standard that you are opting your child out of)"

Identify different kinds of families and explain how families differ for many reasons

Define “friendship” and explain that friends are important throughout life

Explain the differences and similarities of individuals and how people express themselves

2nd Grade Units of Study (Only complete if your child is in grade 2)