Dear Parent/Guardian/Student:

Healthful Living is taught by the North Carolina Virtual Public Schools (NCVPS) in conjunction with the
Healthful Living Curriculum in accordance with the North Carolina Standard Course of Study (NCSCOS).
We at NCVPS recognize parents as the primary healthful living educators and respect parents who
choose to present this subject matter to their children themselves. However, we also recognize that some
subject matter is sensitive to parents, and they may prefer for this information to be presented by health
professionals. A description of the Healthful Living Online Course is attached. You can view the course
online from April 20, 2009 - June 15, 2009. To access the Sample Healthful Living course, go to
http://ncvps.blackboard.com. Login with User ID of healthful_living and password of physical.

- Please read the attached course description and guidelines for the Health Education / Healthful Living
curriculum.
- Please indicate your decision for your child to take (or not take) this online course offered by NCVPS on
the form below by signing and returning the completed form to your child’s guidance counselor or
Distance Learning Advisor.
- If you have questions, you may contact your child’s guidance counselor/Distance Learning Advisor or
NCVPS.

Parental Permission Form For online Health Education / Healthful Living with the NCVPS.
Name of Student: ______________________________________________________________

Name of Student’s School ________________________________________________________

County/LEA in which Student’s School is located _______________________________________

Name of parent/guardian: ____________________________________________

Home phone #: ____________________ Cell phone #:_________________

Please check below to indicate the participation of your child.

_____ I do give permission for my child to participate in NCVPS’s Healthful Living online course.

_____ I do not give permission for my child to participate in NCVPS’s Healthful Living online course.

(If you choose for your child not to participate, your child will not be able to take this class on-line at
NCVPS.)

Signature: ________________________________ Date: __________________

Return this form to your child’s guidance counselor/Distance Learning Advisor.

Distance Learning Advisor, please fax completed form to 919-513-2557 or photocopy form and email as
attachment to Robert Belton at rbelton@dpi.state.nc.us. Or snail mail to Robert Belton, POB 487, Lumber
Bridge, NC 28357.

Healthful Living Form Revised 04/09