Submit by Email
VOLUNTARY CONSENT TO
PARTICIPATE IN TEXAS
SCHOOL SURVEY OF DRUG
AND ALCOHOL USE
Student’s Name:
Date of Birth:
Grade:
Campus:
Parent/Guardian Name:
I give permission for my child, identified above, to participate in the Texas School Survey of
Drug and Alcohol Use. My signature below verifies that I have read and understand the
Information Sheet which has been provided to me. I understand that participation in The Texas
Survey is completely voluntary and that there will be no adverse consequence for any student
choosing not to participate. I also understand that the results of the survey are completely
anonymous and answers cannot and will not be traced back to any single student.
__________________________________________________________
Parent’s Signature
Parent’s Name (printed)
Date
By clicking submit, you are hereby consenting and authorizing for your child to participate in the Texas State School Drug Survey. Print Form