Your child is being asked to be a part of our school’s California Healthy Kids Survey (CHKS) sponsored by the California Department of Education. This is a very important survey that will help promote better health among our youth, improve the school learning environment and combat problems such as drug abuse and violence. We will administer the survey on Friday, October 23 during your child’s seventh grade science class period. Please read this form for information about the survey, and for instructions on how to withdraw your child. If you do not want your child to complete the survey, you must notify your school.
Survey Content. The survey gathers information on developmental supports provided to youth; school connectedness and barriers to learning, as well as behaviors such as physical activity and nutritional habits; alcohol, tobacco and other drug use; and school safety.
Note: In 2009 Marin County 7th, 9th and 11th graders will also be asked about issues related to school and personal achievement, access to physical activity, healthy foods, tobacco and alcohol. These questions will better enable our County to assure programs are planned and delivered in a manner consistent with the needs of our students. At Del Mar, we have used our most recent survey results to plan advisory, lunch-time, and other programs to best meet student needs.
You may examine the questionnaire in the school office or at our school’s Web site.
The results from this survey are compiled into district and county-level CHKS Reports. We will inform you of when results are available and how to view them online.
It is Voluntary. Your child does not have to take the survey. Students who participate only have to answer the questions they want to answer and they may stop taking it at any time.
It is Anonymous. No names will be recorded or attached to the survey forms or data. The results will be made available for analysis only under strict confidentiality controls.
Potential Risks. There are no known risks of physical harm to your child. Risks of psychological or social harm are very small. None have been reported in seven years of survey administration. In rare instances, some discomfort might be experienced from the questions. The school’s counseling services will be available to answer any personal questions that may materialize. For Further Information. The survey was developed by WestEd, a public, non-profit educational institution. If you have any questions about this survey, or about your rights, you may contact: Alan Vann Gardner, Assistant Principal (firstname.lastname@example.org or 435-1468).
If you do not want your child to participate, complete the form below and return to school.
HKS Passive Consent Form (Adobe Acrobat File)
HKS Middle School Core Module (Adobe Acrobat File)
HKS Middle School Custom Module (Adobe Acrobat File)
HKS Passive Consent Form
HKS Middle School Core Module
HKS Middle School Custom Module
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