Parent/Guardian Consent Form

I hereby give permission for my son/daughter to participate as a Youth Leader/Educator in the substance misuse prevention coalition. I understand that my child will be specially trained to educate peers and their families, as well as middle school students, and community members through trainings, promotional activities, media campaigns, and community advocacy.

I understand that my child will be required to sign a contract and commit themselves to a substance-free lifestyle (including alcohol, tobacco, and illegal substances). Should it come to the attention of the other youth leaders/staff/adult volunteers that my child has been unable to adhere to the pledge, I understand that I will be required to meet with my child and Peer-Led Team coordinators to support my child in being substance-free and making healthy choices.

Please provide first, middle, last name.
* Please use your mouse or touchpad to write your signature on the line above