Sarasota County Students Working Against Tobacco (SWAT) Registration 2021-2022 School Year

SWAT is Florida's statewide youth organization that mobilizes, educates, and equips Florida youth to revolt against and de-glamorize Big Tobacco. These empowered youth work towards a tobacco free future by advocating for policies which reduce the prevalence of tobacco use among youth and adults, reduce the influence of the tobacco industry in our local community, and reduce exposure to secondhand smoke. SWAT is found in every county in the state of Florida. The Sarasota County SWAT program is guided by the Florida Department of Health in Sarasota County (FDOH Sarasota). Sarasota County SWAT is composed of numerous student-led clubs. These clubs require the coordination of an adult advisor.

Question Title

* 1. Student Contact Information

First Name *

Last Name *

Address *

Address 2

City/Town *

ZIP Code *

Student Email (If applicable)

Student Phone Number

Question Title

* 2. What is the student's date of birth (DOB)? (enter 2-digit month, 2-digit date, and 4-digit birth year; for example, 01/01/2002)

Question Title

* 3. What race is the student?

Question Title

* 4. What gender does the student identify as?

Question Title

* 5. SWAT Club Affiliation

Name of School/ Boys and Girls Club

What grade are you in?

Question Title

* 6. Student Shirt Size (unisex adult sized T-shirts)

Small

Medium

Large

2XL

Question Title

* 7. Parent/Guardian Contact Information

First Name *

Last Name *

Address *

Address 2

City/Town *

State *

ZIP Code *

Email Address *

Phone Number *

Question Title

* 8. Emergency Contact Number

Parent/Guardian Permission:
This section must be completed by a parent/guardian.

I hereby grant permission for the student/child listed above to participate in the Students Working Against Tobacco (SWAT) program of Sarasota County for the period of time from July 1, 2021 through June 30, 2022. This may include various educational programs and field trips to sites around the state of Florida. I understand that we will be notified in advance of all field trips and be required to give permission for each individual event requiring transportation services. I understand that under present Florida law, if my child is riding in a private automobile that is involved in an accident, he/she will be primarily covered for bodily injury under my family automobile policy, and I agree to submit any medical bills incurred to my insurance company for payment. If my policy has been insured with a deductible clause relative to the personal injury protection, I understand that I have assumed that deductible amount when I purchased the policy.

Question Title

* 9. Do you grant permission as described above?

I grant permission.

I do not grant permission.