Consent Form

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Consent Form

Congratulations! A teen in your life trusts you and requires your consent to participate in a sex positive program about having healthy relationships with themselves and others.

Teens need 5 adults they can trust in order to have healthy development. I, Auntie Julia, am happy to be one of those 5. This form will give me better insight into what you know about the teen and their life.

We may be discussing things like: physical anatomy, relationship orientations, sexual orientations, pleasure, birth control options, and desire.

I will follow up with you via email once receiving this form.

Please note: I am pro-choice and pro-comprehensive sex education. My goal is to help teenagers have healthier relationships as they move throughout their lives.

First and Last Name *

Email *

Teen's Name & Age *

What age range are you and your child comfortable having in the room (11-18)? *

Would you like to be in the room, off camera and silent, while this discussion is happening? *

Yes

If my kid wants me there

I would like there to be a second sex educator on the call *

Yes, please

I'm happy with Auntie Julia

Are you comfortable if parents/guardians are listening in, silently? *

Yes

So that I know your background (select all that apply): *

I have received comprehensive sex education at school

I have received abstinence only education at school

I have received basic sex education at school, consisting mostly of anatomy

I am regularly discussing healthy sexuality with the teen

I am regularly discussing healthy sexuality with peers

I live in a sex positive environment

I live in a sex negative environment

I don't know what a sex positive environment is

Required

What is one topic you would definitely like to be discussed in our group? Feel free to use one of the options in the next question. *

Here is a list of potential topics that we will be discussing. Please select any that you are NOT comfortable being part of the slumber party. *

Dating How To

What's happening with my body?!

What's happening with someone else's body?!

Healthy vs. unhealthy relationships

Intercourse (this includes vaginal and anal)

Oral sex

Body hair

Menstruation

Pornography

Sexual hygiene

Consent

Values

Dealbreakers

Other:

Required

What do you want me to know about the teen before we start? E.g. Erin is super anxious; Sam hasn't started dating; Jordan is VERY aware of their own body but doesn't know about anyone else's; I have no idea what's going on with Dani and could use help. *

I am comfortable with the content including a wheel of topics the teens have chosen, and look forward to an email with further details about specific content closer to the Slumber Party *

Yes

I give Julia permission to use photos or video for promotional material. I understand that all materials will be sent to both myself and the teen prior to release for confirmation of said permission. *

I DO consent to the use of photos or videos for promotional materials.

I DO NOT consent to the use of photos or videos for promotional materials.

Canada’s Anti-Spam Legislation (CASL) prohibits the sending of commercial electronic messages unless the sender has received the recipient’s consent first. Please indicate your commercial electronic message preference below. You may withdraw your consent at any time by notifying Julia by email. Information provided will not be shared with a third party. *

I DO consent to receive professional emails from Julia.

I DO consent to the teen named above receiving professional emails from Julia.

I DO NOT consent to the teen named above receiving professional emails from Julia.

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