2022-2023 Kelvin Well-being Pulse Survey Opt - Out
Dear Families, 

California law requires parents be informed of school surveys and have the ability to opt out their child’s participation. This method is commonly known as passive consent, and minimizes administrative burden on schools, maintains student confidentiality, and increases response rates. We hope you will permit your child to participate. If so, there is no need to do anything. If you DO NOT want your child to participate in this survey, please complete and e-sign the form below and list the name of your child who will NOT participate. A separate form must be filled out for each child. This will be valid through 06/30/2023.

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Email *
OPT-OUT *
Required
Student ID # Find in IC or ask school site
Student Last Name *
Student First Name *
School Name *
Grade *
Required
Parent Signature- Please type name to indicate e-signature *
A copy of your responses will be emailed to the address you provided.
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