1. Are you currently a member of the Safe Homes directory (i.e. signed the Safe Homes pledge)? Check one:

Yes.
No.
I am not currently a member, but would like to join.

2. This year, Safe Homes would like to open some programs to all interested parents. What type of Safe Homes programs would you like to attend this school year?
(Please rank in order of preference – "1" for top choice, "2" for second, etc.:)

Educational program with speakers, on topics such as substance abuse prevention and parenting teens.
1 2 3 4

Informal roundtable discussion for parents, without outside speaker.
1 2 3 4

Combination of educational program and informal roundtable discussion.
1 2 3 4

Social event with refreshments.
1 2 3 4

Other:

3. What days and times would you be willing to attend a Safe Homes program?
(Check all that apply):

Monday night
Tuesday night
Wednesday night
Thursday night
Friday night
Saturday afternoon
Sunday afternoon
Other:

4. In 2007, OMHS hosted a Teen Panel program (read more about it here), where teens from area high schools spoke frankly to a group of parents about their experiences with alcohol and drugs, and the role parents could play in promoting safe behaviors. This session was facilitated by a professional counselor. If this program was offered again... (Check one):

I would attend this year, schedule permitting.
I would not attend because this program does not meet my needs.
I would not attend because I attended the last one.
I would attend, and I’d like to help with organizing this event.

5. Optional: If you would like us to contact you about joining Safe Homes or volunteering to help organize a Teen Panel program, please provide your contact information:

Name:
Phone: (Format: XXX-XXX-XXXX)
Email:

Feel free to leave additional comments here: