A discussion between child and parent/caregiver is an important prevention strategy and is required to assist us in confirming attendance at our virtual event. Please complete by November 6, 2023.

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* 1. Please add student name/names below.

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* 2. Please add name of parent/caregiver who attended the presentation.

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* 3. Student/Students: What do you think the presenter would hope you learned from the presentation?  (If there is more than one student, please list answer as Student 1, Student 2, etc.).

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* 4. Parent/Caregiver: What did you like best about the presentation?

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* 5. Student/Students: What will you personally take away from the presentation?  (If there is more than one student, please list answer as Student 1, Student 2, etc.).

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* 6. Parent/Caregiver: Please share a highlight from your discussion.

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* 7. Student/Students: Please share a highlight from your discussion. (If there is more than one student, please list answer as Student 1, Student 2, etc.).

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* 8. Parent/Caregiver: On a scale of 1-5 with 5 being the best, how would you rate the presentation?

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* 9. Student 1: On a scale of 1-5 with 5 being the best, how would you rate the presentation?

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* 10. Student 2: On a scale of 1-5 with 5 being the best, how would you rate the presentation?

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* 11. Student 3: On a scale of 1-5 with 5 being the best, how would you rate the presentation?

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* 12. Any additional comments can be added here.

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