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 decide whether to opt out of the Select Curriculum Program for their youth. This form should be used when a parent or guardian does not wish for their child or family to participate in this program.

This form requires the parent's or guardian's printed name, signature, and date, as well as an indication of whether they do not wish for their youth (age 16 or older) to participate in the program. The form also includes a section for Office Prevention Specialist Use Only, which is intended for internal use by prevention specialists.

The TX HHS Form 5109 is specifically designed for the Youth Prevention Universal Program and only needs to be signed and returned if a parent or guardian does not want their youth or family to participate in this program. By using this form, parents or guardians can exercise their right to opt out of the Select Curriculum Program, ensuring that their child's privacy and autonomy are respected.