Parent Event Registration Form
This event will take place at the Central Valley HS Auditorium on May 16, 2018. Please arrive at 5:30 to sign in and the event begins at 6:00.
What is your name? (First name only is ok if needed) *
Your answer
What grade(s) is/are your child(ren)? *
What School District are you from? *
Did you attend the community events hosted at one of the 4 Beaver County sites this school year? *
On a scale of 1 to 10, how much do you know about drugs and drug abuse? *
Nothing at all
How did you hear about this event? *
What supports or services would you like to access or get more information from at this event? *
Do you need childcare for the evening? If so please list number of children and ages.
Your answer
The following questions are optional
Please note, as mandated reporters if you report something that falls under that statute, we must act on it.
Do you know of anyone who is using illegal drugs?
Do you need help or know someone who needs help?
If you answered "yes" or "maybe" to the previous question, please enter your name and contact information to get in touch with someone who can help you or someone you know.
Your answer
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