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YOUTH ASSENT FORM HOPE PROGRAM

More Than Conquerors, INC.

THE HOPE III PROGRAM


We are doing a program about helping young people avoid having early sexual activity and other risky behaviors. The program is also a way to learn more about people. If you agree to be in the program, you will be asked to fill out an 8-minute survey before the program begins. And you will be asked to fill out a 16-minute survey after the program ends. Surveys will not include any names.


There are some things about this program that you should know. The HOPE III Program helps youth avoid early sexual activity. It also helps youth avoid other risky behaviors. The HOPE III Program will be taught in health or other classes at local schools.


Your parent/guardian has agreed that you can be in the program. The surveys will include questions for students about their living situation and sexual orientation. Questions will ask whether you think the program affected your decision to avoid having sex. Questions will ask whether you have had sex, been pregnant or had sexually transmitted infections. There will also be questions about the use of alcohol, tobacco, or other drugs.


It is possible that your answers could be seen by another student, which may present a risk that you might be embarrassed, or you might get in trouble. However, it is very unlikely that your answers will be revealed. We will make every effort to keep your answers private. If any questions make you feel uncomfortable, you may skip that question. We will also make someone available to talk to you if you would like to do so.


When we are finished with this program, we will write a report about what was learned. This report will not include your name or that you were in the program.


You do not have to be in this program if you do not want to be. If you decide to stop after we begin, that's okay too. If you have any questions, you may contact Mrs. Tina Thomas, Program Director at More Than Conquerors, Inc. at (770) 483-3299.


If you decide you want to be in this program, please fill out the information below.

Date

Please select a session

Session Time
June 18th and 20th:10AM

By clicking the "Submit" button below, I acknowledge that I have read and understood the terms of this consent form, and agree to participate in the HOPE III virtual classes (via Zoom link). I understand that my electronic signature is legally binding, just as if I had signed a physical document.


If you do not see this confirmation message, your form has not been successfully submitted. Please try again or contact us for assistance.

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