Form Sts0113 - Parental Permission Form

ADVERTISEMENT

P-HS
Parental Permission Form
Our school is participating in the Florida Youth Survey 2009 sponsored by the Department of Health,
the Department of Education, and the Department of Children and Families. There are three versions
of the survey. The Florida Youth Tobacco Survey provides information for evaluating the impact of
Florida’s innovative program to prevent and reduce tobacco use. The Florida Youth Substance Abuse
Survey provides important information on alcohol and other drug use, attitudes and behaviors, risk and
protective factors and the community context that influences these variables. The Youth Risk
Behavior Survey provides information on the behaviors that put youth at risk for premature morbidity
and mortality as adolescents and adults. Your child will be asked to complete one of the three versions.
Students may skip any question they do not wish to answer. They also may stop answering questions at
any point during the survey. A copy of the survey is available for your review at the school.
The Florida Youth Survey 2009 has been approved by state and local school officials and has the
support of statewide organizations, including the Governor’s Office, the Governor’s Office of Drug
Control, the Department of Education, the Department of Health and the Department of Children and
Families.
Risk and Benefits of Your Child’s Participation: Completing this paper and pencil survey poses no
risk to your child. Survey procedures have been designed to protect your child’s privacy and allow for
anonymous participation. Students will not put their names on the surveys. No school or student will
ever be mentioned by name in a report of the results. There will be no action against you or your child
if your child does not participate. Participating in this survey will not directly benefit your child.
However, the information collected will be used to better evaluate and plan such programs as Safe and
Drug Free Schools and Florida’s youth tobacco control program.
Please read the section below. YOU ONLY NEED TO RETURN THIS FORM IF YOU DO NOT
GIVE YOUR CHILD PERMISSION TO TAKE THE SURVEY. Please see the other side of this form
for additional information. If you have any questions please contact____________________________
at______________________________.
Thank you for your cooperation.
Child’s Name:
Grade: __________________
I have read and understand this form concerning the Florida Youth Survey 2009:
[ ] My child does not have my permission to participate.
Parent’s Signature: _____________________________________________________________
Telephone Number:
Date: ____________________
STS0113

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 2