TX HHS Form 5109. Youth Prevention Universal Parent/Guardian Opt-Out Signature

The TX HHS Form 5109, Youth Prevention Universal Parent/Guardian Opt-Out Signature, is a crucial document that helps parents or guardians exercise their right to opt-out of the Select Curriculum program for their youth. This form is specifically designed for the Youth Prevention Universal Program and must be signed and returned if you do not wish your child or family to participate in this program.

This form requires the parent or guardian's printed name, signature, and date, as well as a clear indication of whether they wish to opt-out on behalf of their youth (for those under 16 years old) or themselves (if 16 or older). The form also includes a section for Office Prevention Specialist Use Only, which allows for tracking and follow-up actions.

Key points to note include:

• This form only needs to be signed and returned if you do not want your youth or family to participate in the Select Curriculum program.
• The form applies only to the Youth Prevention Universal Program.