Safe Homes Parent/Guardian Agreement

1. I will actively supervise any parties in my home.
2. I will not serve or allow minors to consume alcohol or other drugs in my home or on my property.
3. I will communicate with other parents in an effort to create a safer community for our children.

Parent/Guardian Name(s): *

Home phone (required): *

Email (optional, but strongly recommended):

Address:

Child(s) Name: *

Multiple children may be entered separated by commas (Child 1, Child 2, Child 3, etc.)

Child(s) School: *

For multiple children, separate by commas (School 1, School 2, School 3, etc.)

Child(s) Grade: *

For multiple children, separate by commas (Grade 1, Grade 2, Grade 3, etc.)

Comments:

Agreement: *

By checking here I understand that I am signing up for the Amherst Regional SAFE HOMES program, which includes submitting this electronic SAFE HOMES agreement and having my/our name(s), address and phone number listed in the SAFE HOMES directory. I understand that this information will NOT be used or distributed for any other purpose. I also understand that SAFE HOMES agreements are not legally binding, but are statements of concern and intent. SAFE HOMES and its members are not able to guarantee or enforce compliance.

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