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VMAC Safe Homes Pledge
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THE PLEDGE
SAFE HOMES is a program that empowers parents and guardians to create a community of like-minded people who have pledged to not allow underage alcohol and drug use in their homes and on their property.
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I / we agree to support the ideals of the SAFE HOME program with our children and in our home. We agree to have our contact information shared with like-minded families in Verona to facilitate the protection of our youth.
Required
Is this the first time your family is taking the pledge?
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YES - this is our first time
NO - we are renewing / updating
Required
Information to be Included on the Safe Homes Contact List
Last Name of Child(ren):
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Your answer
What school(s) do your child/children attend?
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Forest Elementary
Laning Elementary
Brookdale Elementary
FN Brown Elementary
Our Lady of the Lake School
HB Whitehorne Middle Scool
Verona High School
Other:
Required
Full Name of Parents/Guardians
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Your answer
Email Address (will be used to send you a copy of the Safe Homes list)
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Your answer
Click here if you do not want your email address displayed in the Safe Homes Contact List
Contact Phone Number
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Your answer
Is this a Home Phone or Cell Phone?
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Home Phone
Cell Phone
Home Address (optional)
Your answer
Additional Information
Please let us know if you would like additional information about the Verona Municipal Alliance Committee, including info on joining the committee
Yes, please have someone from VMAC contact me at the email address I have provided.
Yes, please have someone from VMAC contact me at the phone number I have provided.
No, not at this time.
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Additional Comments / Questions for VMAC:
Your answer
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