Safe Homes Parent Network of Franklin County VT Survey

Franklin County Caring Communities and Rural Partnerships invite you to be part of the “Safe Homes Parent Network” across Franklin County. What is “Safe Homes Parent Network?” It’s a new way for parents to be supported in helping their kids to remain alcohol and drug free, and to connect with other families who have the same policies and goals. We’re inviting parents to “sign on” to the following:

1. Please note: The Safe Homes Parent Network commitment is not a legally binding contract, but rather an agreement between members of the SAFE HOMES Parent Network of Franklin County.

Please show your commitment by checking the boxes below. You may opt not to check the fourth box if you do not wish to share your contact informaiton:

Please note: The Safe Homes Parent Network commitment is not a legally binding contract, but rather an agreement between members of the SAFE HOMES Parent Network of Franklin County. Please show your commitment by checking the boxes below. You may opt not to check the fourth box if you do not wish to share your contact informaiton: 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.

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

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

I will welcome phone calls about activities taking place in my home and on my property.

2. Please complete the information below

Please complete the information below First Name:
Last Name:
Address:
Town:
State:
Zip code:
Phone:
Cell phone:
Email:

3. Please include the following information:

	Child's Grade	Child's School
First Child	Please include the following information: First Child Child's Grade	Child's School
Second Child	Second Child Child's Grade	Child's School
Third Child	Third Child Child's Grade	Child's School
Fourth Child	Fourth Child Child's Grade	Child's School
Fifth Child	Fifth Child Child's Grade	Child's School

Name

4. I am the:

I am the: Parent

Guardian

Other (please specify)

5. How would you prefer to receive communication from the SAFE HOMES Parent Network of Franklin County? (Mark all that apply)

How would you prefer to receive communication from the SAFE HOMES Parent Network of Franklin County? (Mark all that apply) Postal mail

E-mail (your email address must be entered above)

Automated phone calls (your phone number must be listed above)

On-line social network groups (Twitter, facebook, etc.)

6. We would like permission to publish your name as a member of the Safe Homes Parent Network of Franklin County in the Safe Homes directory. This directory will be made available to other parents/guardians who have joined the Safe Homes Parent Network. Please indicate below if we may do so.

We would like permission to publish your name as a member of the Safe Homes Parent Network of Franklin County in the Safe Homes directory. This directory will be made available to other parents/guardians who have joined the Safe Homes Parent Network. Please indicate below if we may do so. I GIVE PERMISSION to publish my NAME and CONTACT INFORMATION.

I GIVE PERMISSION TO publish my NAME and TOWN ONLY.

I DO NOT give permission to publish my information.

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2. Please complete the information below

3. Please include the following information:

4. I am the:

5. How would you prefer to receive communication from the SAFE HOMES Parent Network of Franklin County? (Mark all that apply)

6. We would like permission to publish your name as a member of the Safe Homes Parent Network of Franklin County in the Safe Homes directory. This directory will be made available to other parents/guardians who have joined the Safe Homes Parent Network. Please indicate below if we may do so.

Safe Homes Parent Network of Franklin County VT
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