Safe Homes Pledge
Did you know that parents are the #1 reason why youth choose not to use drugs or other substances?
Make the pledge to help support the wellbeing of youth (under the age 21) in our community. 
Sign in to Google to save your progress. Learn more
Email *
Date *
MM
/
DD
/
YYYY

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

 *
Required

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

 *
Required

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

 *
Required

I/We will model responsible behavior when consuming alcohol around youth and will not take or give out medications prescribed for others.

 *
Required
First Name & Last Name *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
GoogleForms
reCAPTCHA
PrivacyTerms
This form was created inside of Gold Hearts and Crowns.