Dear Madam:

No body of government may legally refuse a child’s right to an education for the failure to undergo testing for a condition that poses no risk to others.

I hereby declare that, I, _______________________, as the custodial parent having responsibility for my child, _______________________, who is a minor child enrolled in the ________________________ School, have not yet consented to Lead testing _______________________.

I further assert the following:

_______________________ has not exhibited any of these of symptoms.

I have included these assertions to show that _______________________ is low-risk for lead poisoning, and that the fact that she has not been lead tested, in no way demonstrates a lack of love, concern, or care for her and her well-being from her family. Furthermore, our family will challenge any governmental body who seeks to deny _______________________ the right to an education because she has not been lead tested.



Notary Public:

__________________________       ________________ _

Signature                                Date

__________________________        ________________ _

City, State,                     My Commission expires