Your child has been asked to participate in a focus group sponsored by _________________ on behalf of a grant through the New Mexico Office of Substance Abuse Prevention. In this focus group, we will ask questions about alcohol and prescription drug use. Nobody participating in the focus group will be identifiable, and the information that the participants provide will serve to help our coalition design our prevention strategies so they have the most impact. Doing this focus group will cause little or no risk to your child. The only potential risk is that some students might find certain questions to be sensitive. The focus group asks no questions about personal or individual substance use and behaviors, but asks participants to reflect upon what they see in their community. No one will ever be mentioned by name in a report of the results. This focus group is voluntary. Anyone may decline to participate, cannot respond to questions that they do not wish to answer, or can stop/withdraw at any time from the group without penalty. No action will be taken against you or your child, if your child does not take part. Please read the section below and check one box. Return the form to ______ by the date below. If you have questions about the focus group, please call ________________________ . If you cannot reach this person, please call Dr. Liz Lilliott at 575-313-7029 or 505 765-2330; lilliott@pire.org Thank you. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - NAME OF COALITION Date of Focus Group: Location: I have read this form and know what the survey is about. □ Yes, my child may participate in the OSAP youth focus group □ No, my child may not participate in the OSAP youth focus group Parent or Guardian’s signature: _______________________ Date: ________ Passive Parental Consent Form
Your child has been asked to participate in a focus group sponsored by _________________ on behalf of a grant through the New Mexico Office of Substance Abuse Prevention. In this focus group, we will ask questions about alcohol and prescription drug use. Nobody participating in the focus group will be identifiable, and the information that the participants provide will serve to help our coalition design our prevention strategies so they have the most impact. Doing this focus group will cause little or no risk to your child. The only potential risk is that some students might find certain questions to be sensitive. The focus group asks no questions about personal or individual substance use and behaviors, but asks participants to reflect upon what they see in their community. No one will ever be mentioned by name in a report of the results. This focus group is voluntary. Anyone may decline to participate, cannot respond to questions that they do not wish to answer, or can stop/withdraw at any time from the group without penalty. No action will be taken against you or your child, if your child does not take part. Please read the section below and check one box. Return the form to ______ by the date below. If you have questions about the focus group, please call ________________________ . If you cannot reach this person, please call Dr. Liz Lilliott at 575-313-7029 or 505 765-2330; lilliott@pire.org Thank you. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - NAME OF COALITION Date of Focus Group: Location: I have read this form and know what the survey is about. □ Yes, my child may participate in the OSAP youth focus group □ No, my child may not participate in the OSAP youth focus group Parent or Guardian’s signature: _______________________ Date: ________ Passive Parental Consent Form