Directions: Print this page and complete
the form. After the Consent form is signed, mail it to:
Region 6 Eastern Idaho Professional-Technical High School
1600 S 25th E
Idaho Falls, ID 83404.
A separate consent form
is not required when enrolling in Part II if one was submitted for Part I.
Please read the Course Description so you can support your student in successfully completing this Internet course. Students need to be highly motivated for this independent course work. The course description can be found at http://www.eitc.edu/academics_online-intro.htm
Parental Consent is required for minor students due to the course content on body systems (including the Reproductive System) and healthy lifestyles, which includes a section on sexual health. For more specific content please contact the course instructor (Susan Sorensen, (208) 524-3000 Ext 3322 or email: firstname.lastname@example.org.
Parent or guardian's mailing address:
Street Address: __________________________
Phone Number: __________________________
Parent or Guardian Signature: ___________________________________