Youth Risk Behavior Survey

2018 YRBS PASSIVE PARENTAL PERMISSION FORM

Our school takes part in the Wisconsin Online Youth Risk Behavior Survey sponsored by CESA 11 every other year. The next time will be in the fall of 2021. The survey will ask about the health behaviors of 7 through 11 grade students. Grades 9, 10, and 11 will be participating during the first week in March. Grades 7 and 8 will be participating during the last week of March. The survey will ask about behaviors that result in unintentional and intentional injuries, tobacco use, and alcohol and other drug use. It will also ask about sexual behaviors that may result in HIV infection, other sexually transmitted diseases, and, unwanted pregnancies and dietary behavior and physical activity.

Students will be asked to fill out a computer-based questionnaire that takes about 25 minutes to complete. They will take the survey during regular class time.

Completing this anonymous survey 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 survey has been designed to protect your child’s privacy. Students will not put their names on the survey. Also, no class or student will ever be mentioned by name in a report of the results. Your child will get no benefit right away from taking part in the survey. However, the results of this survey will help children in the future by influencing health and safety programs. We would like all selected students to take part in the survey, but the survey is voluntary. No action will be taken against you, or your child, if your child does not take part. Students can skip any question that they do not wish to answer. In addition, students may stop participating in the survey at any point without penalty.

Please see the attached handout for more facts about the survey. If you have questions about this survey - call Montana Weaver at 715-349-2277 ext 313.

If you do not want your child to take part in the survey please email Ms. Weaver mweaver@siren.k12.wi.us . This will dismiss your child from taking the survey. If you have no objection to your child taking part in the survey, you should do nothing. Thank you.