Parent/Guardian Permission Form
Healthy Choices, Relationships, and Sexual Health Discussion — Men 2 Be
Dear Parent/Guardian,
My name is Thadious Brown, M.Ed., Clinical Mental Health Counseling, LPCA, and I am requesting your permission for your son to take part in a guided group discussion about healthy choices, relationships, and sexual health through Men 2 Be.
Young men in our program are at an age where they hear many messages about sex from friends, social media, and the internet—and much of that information is inaccurate or confusing. My goal is to provide accurate, respectful information in a safe setting and to help them make thoughtful decisions that reflect their own values and their family's values.
Topics We Will Cover
• Understanding sex and sexual health—basic, accurate, age-appropriate information
• Why wait—the benefits of delaying sexual activity, including emotional, physical, and future goals
• Virginity—what it means, and respecting your own choices and the choices of others
• Peer pressure—recognizing it, resisting it, and feeling confident saying “no”
• Being safe—consent, respect, and healthy relationships
• Protection—how condoms and other protection help prevent pregnancy and sexually transmitted infections (STIs)
How the Discussion Will Work
Date(s): November 26, 2026
Time: 5:30 PM
Location: 1605 Phelps Avenue
• The discussion will be age-appropriate. When possible, younger participants (ages 11–14) and older participants (ages 15–18) will meet in separate groups.
• Participants are encouraged to ask questions; no one will be required to share personal information.
• Your son may choose not to answer any question or may step out of the discussion at any time.
Privacy and Safety
What participants share will be kept private. However, as a counselor, I am required to report information if a youth is in danger, is being harmed, or may harm himself or someone else.
This is an educational group discussion, not individual counseling or medical care.
Questions or Previewing Materials
You are welcome to contact me with questions or to review the discussion materials in advance. I also encourage you to continue the conversation at home.
Contact: Thadious Brown, M.Ed., Clinical Mental Health Counseling, LPCA | [Phone] | [Email]
Thank you for your support and trust.
Sincerely,
Thadious Brown, M.Ed., Clinical Mental Health Counseling, LPCA
Men 2 Be
Please keep this page for your records and return the permission response form by: ____________________
Permission Response Form
Youth’s Name
*
First Name
Last Name
Age
*
Permission response — Please check one
*
YES, I give permission for my son to take part in the Healthy Choices, Relationships, and Sexual Health discussion.
NO, I do not give permission for my son to take part in this discussion.
I would like to be contacted before the discussion to ask questions or review materials (optional).
Parent/Guardian Name (print)
*
First Name
Last Name
Parent/Guardian Signature
*
Date
*
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Comments or questions for the counselor
For office use only
Received by
Date received
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Permission Form
Submit Permission Form
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