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 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.

Throughout our time together we will be working on confidence, boundaries, communication, empathy, consent, being aware of our needs and respecting others'. My intention with this program is to provide the tools and help develop the skills to sustain healthy relationships of all types throughout their lives. Ideally, the teens will really enjoy themselves throughout the process, form lasting friendships with their group members, and gain important information that will set them up for the rest of their lives.

We will be discussing things like: physical anatomy, relationship orientations, sexual orientations, pleasure, and desire. You can find more detail at my website: www.juliasheldon.com/offerings

I will follow up with you via email once receiving this form, particularly about the subjects you yourself are not comfortable discussing, but that you'd like me to cover.

First and Last Name *

Email *

Teen's Name *

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'd like for me to address. *

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'm noticing some problematic behaviours that I'd love you to address if you can. *

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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