The HOPE III Program

Healthy Options for Personal Empowerment III

Parental Consent Form

Dear Parent/Guardian,

Your child has shown interest in participating in a sexual risk avoidance education (SRAE) and youth development program called The HOPE III Program. The HOPE III Program is under the auspices of More Than Conquerors, Inc. (MTCI). The program will expose youth on how to voluntarily refrain from non-marital sexual activity and prevent at risk youth behaviors. The HOPE III Program activities will teach the benefits of self-regulation, poverty prevention, healthy relationships, goal setting, resisting sexual coercion, dating violence prevention, and other youth risk behaviors such as underage drinking and illicit drug use without normalizing teen sexual activity. Scheduled classes will be held to discuss sexual risk avoidance education, addressing high STI/STD rates and teenage pregnancy prevention rates. We would like permission for your child to participate in this program. Social media will also be utilized to further reinforce healthy behaviors.

The class date is for September 24rd and 25th starting at 10 a.m. to 2 p.m. If you consent, your child will be asked to take part in an evaluation of the programming utilizing an entry and exit survey. These surveys will be collected virtually (on-line) through a survey instrument that can be accessed via your child’s mobile phone. If they choose to participate, they will be asked questions about their knowledge and perceptions related to sexual risk avoidance, current and past sexual activity, consequences of engaging in sexual activity as a teen, as well as what they have learned in the program. The information gained from the evaluation may contribute to a better understanding of The HOPE III Program. The information collected will be summarized and reported only in group form. Information that is gathered about your child will be confidential and not be reported to anyone outside of the evaluation that in any way identifies them. You may refuse to take part in this evaluation. If you choose for your child to take part, they may stop at any time. If you refuse for your child to take part or if your child decides to stop answering the questions, your child will not be penalized and will not lose any benefits from the sexual risk avoidance program to which they are entitled.

If you have questions about The HOPE III Program, please feel free to contact Mrs. Tina Thomas, HOPE III Program Director at (770) 483-3299.

If you AGREE FOR YOUR CHILD TO PARTICIPATE, PLEASE SIGN BELOW.

I have read and understood the above and, I agree for my child to participate.

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

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