LCS Resiliency Survey - Opt-Out Form
Dear Parent/Guardian(s):
If you do NOT wish to have your student participate in the Lebanon School District Resiliency Survey, please submit this form indicating your refusal to grant permission for your student to participate by January 6, 2020.
* Required
Student Name (Last Name, First Name)
*
Your answer
Student ID
*
Your answer
Building
*
Choose
Bowman Primary
Donovan Elementary
Berry Intermediate
Lebanon Junior High
Lebanon High School
Other
Grade level
*
Choose
3
4
5
6
7
8
9
10
11
12
Consent Refusal
*
I do not wish for my child to participate in the District Resiliency Survey
I understand that my consent shall be refused until such time as I provide written consent for my student to participate.
Required
Submitted by: (Parent/Guardian Name)
*
Your answer
Submit
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