Parent Opt-in Form: Suicide Prevention & Internet Safety Presentation 

The presentation is a mother's depiction about the life her son led, and how we as a society have been impacted by the act of image-based extortion. This story is to bring awareness and hopefully impact to save more lives. 

Email *
Student's First and Last name *
Grade *
Parent/Guardian Name *
Parent / Guardian Phone # and/or email address *
Permission to Participate *
Parent signature (type your name below to serve as your signature)  *
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