Sex Ed for Everybody - Tween Edition, Fall 2024

Sex Ed for Everybody - Fall 2024

Tween Edition
Name of Participant:*

First NameLast Name
Participant's pronouns:*
Age of the person attending (ages 9-13):*
Participant will attend the following dates:*

Entire series9/11/249/18/249/25/2410/9/2410/16/24
Any specific topics that the participant would like to be covered/discussed?*
Participant's Email:
example@example.com
Name of Parent/Guardian:*

First NameLast Name
Parent/Guardian's Email:*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Tuition

We offer a scaled payment structure for Sex Ed for Everybody with three payment options rather than one fixed price. This structure makes it possible for more people to access these classes with community support, and provides an opportunity for those with more access to resources to support others.

Please choose the option that feels appropriate to you and your circumstances.

Supportive: $45 per class/$300 for the series
Fair: $30 per class/$200 for the series
Supported: $15 per class/$100 for the series

All donations are tax deductible!

Please click here for payment link.

In order to reserve your spot, payment must be received by 09/10/24 midnight PST.

When payment is received info on class will be emailed within 48 hours. If you do not receive an email, please email bodyliteracycenter@gmail.com
I have sent my chosen donation to the link above:*

Yes!Scholarship Application (see below)
We have limited scholarships available. To apply, please tell us a little bit below about why you require assistance at this time.
I,   First Name*   Last Name*   , acknowledge that I am enrolling my minor child,   First Name*   Last Name*   , in a comprehensive body literacy and sex education class taught by Pamela Samuelson and DanRae Wilson entitled Sex ed for Everybody, taking place online from 9/11 - 10/16 2024.

As such, I acknowledge that I consent to my child receiving this material from Pamela Samuelson and DanRae Wilson.   Initials*

I am aware that the group may include students between the ages of approximately 9 and 13, and consent to my child  participating in a mixed-age group   Initials*
I acknowledge that the material covered may include:
- Frank, forthright, medically accurate answers to all questions that are asked by any student present, without exception
- Accurate anatomical images of sexual and reproductive anatomy
- A discussion of sexuality, gender, and orientation that is inclusive of all identities, preferences and choices as valid
- A discussion of consent and agency as a vital aspect of all behavior
Initials *
I hereby voluntarily release, forever discharge Pamela Samuelson, DanRae Wilson, The Center for the Advancement of Body Literacy, its officers, directors, employees, volunteer and agents from any and all claims, demands, or causes of action, which are connected with my child's participation in this program.

The information I've given in this form is complete and accurate. By signing this form, I confirm that I have fully informed myself of the contents of this Parental Consent and Release Form by reading it before I signed it.

I warrant that I possess all the rights, powers, and privileges of a parent or legal guardian necessary to execute this document with binding legal effect.
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Sex Ed for Everybody - Fall 2024