SAFE HOMES PLEDGE FORM

I/We will actively supervise all gatherings or parties of youth in our home, on our property, or ask another responsible adult for help to do so.

I/We will not allow the possession or use of alcohol, tobacco, marijuana, other drugs, or violence by youth in our home or on our property.

I/We will set expectations for my/our children by knowing where they are going, who they are with, what their plans are, and when they are to return home.

Name:
Address:
 
Phone: (home)
  (work)
Email Address :
Children's Names:  
1. Grade:
School:
2. Grade:
School:    
3. Grade:
School:    
I/We wish to be included in the SAFE HOMES Parent Directory.
My phone number is not to be published.
My address is not to be published.

Please return to The Coalition for Drug Abuse Prevention, 8025 North Point Blvd, Suite 225, W-S, NC 27106.
(336-759-7500)
(This pledge is not a legally binding contract, but rather an agreement between the network of parents.)

 
 
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