PREP Consent Form

This consent form authorizes your teen to attend a youth development program hosted by PREP Manchester. The course may be conducted virtually or in-person at Amoskeag Health.

We teach Get Real, which is an evidence-informed curriculum that is offered through Amoskeag Health. The program teaches teens how to prevent HIV, other sexually transmitted Infections( STIs), and pregnancy. Trained health educators from Amoskeag Health provide participants with accurate, comprehensive information to empower them to make choices today to support their long-term goals. We discuss abstinence, contraceptive options, healthy relationships, communication skills, and how the decisions we make now can impact our future. Teens who complete the program can earn a $100 Amazon gift card and are eligible for school credit through the Manchester School District.

You are welcome to preview the program materials. Please contact Lesly Anguiano lpadilla@amoskeaghealth.org (603) 722-3002 at Amoskeag Health and we will arrange a preview time and answer any questions you may have about the program.

Sincerely,

Lesly Anguiano , PREP Program Facilitator/ Coordinator

*If your student is requesting ELO Credit ; this form will be shared with the ELO program coordinator*

Parent or Guardian's Full Name *

First Name Last Name

Class Participant's Full Name

First Name Last Name

Please sign below to grant permission for the participant listed above to attend PREP Manchester classes and participate in the PREP Manchester program.

Parent or Guardian's Signature *

Clear

Date

PREP Parental/Guardian Consent Form