SAFE HOMES  PARENTS NETWORK

"Parents, guardians, and community working together for drug-free youth."

 

 PARENTS PLEDGE FORM

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

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

3.      I will set expectations for m children by knowing where they are, whom they are with, what they are doing, and when they are to return home.

NAME (print) _______________________________  PHONE (home) _________ (work) _________

ADDRESS ________________________________ CITY/STATE  _______________  ZIP___________

SIGNATURE OF PARENTS

__________________________________________________________________________________

Children’s Name                                                                                              School

1._____________________________________________________________________________________________

2._____________________________________________________________________________________________

3._____________________________________________________________________________________________

__*I wish to be included in the SAFE HOMES  Parents Directory      yes ________ no _________

*My PHONE number is NOT to be published (check here____ )

*My ADDRESS is NOT to be published (check here _____ )

PLEASE SIGN

 ____________________________________________________________________________

Return this form to your school or sponsoring organization or return it to PRIDE-Omaha Inc., 3534 South 108 Street, Omaha, NE  68144,  402-397-3309.

[This pledge is NOT a legally binding contract, but rather an agreement between the network of parents]