Safe Homes Pledge:

Safe Homes Pledge
The median age at which children begin drinking is age 12 (NIDA, 2002). In Castro Valley, 32% of 11th graders reported using alcohol in the last 30 days. (California Healthy Kids Survey, 2007). Young people who begin drinking before age 15 are four times more likely to develop alcohol dependence than those who begin drinking at age 21. (NIAAA, 2002)

Will you help to change these statistics?

When you join SAFE HOMES, you’ll be included in a directory with other SAFE HOMES families. You can use this directory to determine if your child is invited to a SAFE HOME. After you submit your pledge (online or paper), you will be emailed a .pdf list of families who have signed the pledge (or mailed if you have no web acess). The pledge needs to be renewed annually, and you can request to have your name removed from the Directory at any point in the future. The list will be updated monthly, and a new pdf available.
 
I pledge to have a SAFE HOME -
Safe from Alcohol, Tobacco & Other Drugs, Firearms & Other Hazardous Items
When hosting students in our home or on our property . . .
• I will be present and visible
• I will not provide or allow access to alcohol, tobacco, drugs or medications
• I will provide secure storage of fire arms and other potentially hazardous items
• I will encourage future drug and alcohol free activities for underage youth

Please fill out the form below. Each month we will email you the Safe Home List. You must have an email address listed to receive the email.

Please note: fields marked with a "*" are required.

 

Student Last Name *

Please enter the students last name

Student First Name *

Please enter the students first name

Student #2 Last Name

Optional - if there is a second child living in the safe home

Student #2 First Name

Optional - if there is a second child living in the safe home

Student #3 Last Name

Optional - if there is a third child living in the safe home

Student #3 First Name

Optional - if there is a third child living in the safe home

Safe Home Street Address *

Please enter the street address of the Safe Home

Safe Home City *

Please enter the City of the Safe Home

Parent / Guardian #1 Last Name *

Please enter the last name of parent #1

Parent / Guardian #1 First Name *

Please enter the first name of parent #1

Parent / Guardian #1 Email

Please enter the email address for parent #1

Parent / Guardian #1 Home Phone *

Please enter the phone number for parent #1

Parent / Guardian #2 Last Name

Please enter the last name of parent #2

Parent / Guardian #2 First Name

Please enter the first name of parent #2

Parent / Guardian #2 Email

Please enter the email address of parent #2

Parent / Guardian #2 Home Phone

Please enter the phone number for parent #2

Parent / Guardian #1 Cell Phone

Parent / Guardian #2 Cell Phone

Attachments
 

 

Student 1: Last Name *
Student 1: First Name *
Student 2: Last Name
Student 2: First Name
Student 3: Last Name
Student 3: First Name
  
Safe Home Street Address *
Safe Home City *
Please the Safe Home StreetPlease enter the Safe Home City
    
Parent / Guardian #1Parent / Guardian #2
Last Name *
Last Name
First Name *
First Name
Email *
Email
Home Phone *
Home Phone
Cell Phone
Cell Phone
 

 By signing the SAFE HOMES pledge...

you will join thousands of other parents who are actively trying to help prevent underage drinking and teen drug use. None of us can guarantee that our children won’t try alcohol or drugs at some point, but
by signing the pledge, we let our minor children know that drinking and drugs are against the law and against our family values and beliefs.

I understand that the information listed in the SAFE HOMES Directory will be available to all parents
who sign the pledge, and the information will not be used or given out other than the purposes intended.

Frequently asked questions about Safe Home Network

*We reserve the right to remove members who have not complied with the pledge.

Questions? Call 510-537-3335 x 1936, fax 510-537-4754.

The pledge is a good faith promise, not a legal contract