*1.I pledge to immediately refrain from any use of any substances or drinks that alter or impair my mental or physical state while operating any form of transportation. I am committed to ending the negative repercussions of Impaired Driving by being a focused, responsible driver. I hereby pledge this life-long commitment. (sign name below)(Required.)

*2.School/Organization(Required.)

3.Grade (if applicable)

*4.Email Address(Required.)

*5.Gender(Required.)

Male

Female

Non-Gender Specify

*6.Age(Required.)

12 and under

13 - 17 years old

18 - 30 years old

31 -50 years old

51 - 65 years old

66 and older

*7.I would like to be added to the CARES Club email list(Required.)

Yes

No