Take the Pledge

Congratulations on making the powerful choice to be healthy.   Please answer a few simple questions about yourself, and take the pledge. Tell us why you have decided not to vape or smoke, and leave your email addresss.  You will be entered in to a raffle to win AirPods or gift cards.

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* 1. What is your high school graduation year?

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* 2. What is your gender?

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* 3. What language is primarily spoken at home?

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* 4. What school do you attend?

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* 5. Do you think that vaping is harmful to your health?

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* 6. I Love My Lungs, and I pledge to not smoke or vape. I pledge to share the dangers of smoking and vaping with my friends, and will encourage them to take the pledge.

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* 7. Why have you made the choice to not to vape or smoke?

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* 8. What is your email address? 

Your email will be used to notify the winners of AirPods and gift cards.  Your email address will also be used for future communication from the Drug-Free Task Force about the dangers of vaping and smoking.   You will be able to opt out of email notifications.   All communication will be from the Drug-Free Task Force.  Your email will not be shared or sold to any other organization.

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* 9. I am over the age of 13, or have permission from a parent or guardian to complete this form.

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