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Online Parent Pledge

We invite you to join other concerned parents/guardians in helping to create a healthy, drug free lifestyle for our youth by submitting the Parent Pledge below.  You can print a hard copy of your completed pledge to share with your child.

The Parents Committed Pledge

“I will ensure that all social events in my home for teens are chaperoned by a parent and that I will not serve alcohol or allow alcohol or other drugs to be accessible to or consumed by teens at my home.

I also agree to inform my son or daughter that I have signed this pledge.”

Please complete the form below. Fields marked with an * are required.

Parent/Guardian Information
First Name*
Last Name*
Email
Phone (optional)
 
Student Information
How many students are you pledging for?*
Please enter the names and grades of the students below. (Optional)
 
School
   
If you provide your mailing address below we will mail you a free refrigerator magnet with the Parent Pledge printed on it. Your address will not be displayed on our website.
Address
City State Zip

 If you wish to be included in our online Parent Directory so that other parents may contact you, check the box below. This directory will remain private and will be accessible only to others who have agreed to be included in the directory.

Yes, I grant permission to the Santa Ynez Valley Youth  Coalition to list my contact information in the online directory.