Dear Parent/Guardian,

Your school will begin offering the Defiance County Youth Tobacco Survey, to 9th-12th grades students during Fall 2025. This purpose of the survey is to understand youth awareness and attitudes related tobacco and vaping policies. The survey is 11 questions. To view the survey, click here.

This survey uses passive consent, meaning parents must be made aware of the survey and given the opportunity to opt their students out of participating. If you do not wish your child to participate in the survey, please complete this form. If you do not sign the paper form or complete this survey, your child will receive the survey.

If you have any questions about the Defiance County Youth Tobacco Survey in your school, you may contact Bridget Fischer at Defiance County Health Department at bfischer@defiancecohealth.org.

Question Title

* 1. Are you choosing to opt-out of your child to complete the Defiance County Youth Tobacco Survey?

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