Be visible and available when hosting a
teen party
Not allow teen parties or gatherings to
take place when I am not home
Find out the contact information of my
child’s friends and their parents
Discuss this campaign with my child
Know the laws associated with furnishing
alcohol and allowing parties to occur in your home
Contact a youth’s parents to
pick them up if they are under the influence
Make sure that all alcohol is locked up
and closely monitored by me
Your name and personal
information will be held private and you will not receive any contact
from
Circuit Rider Productions, Inc. or any third parties
without your indicated interest.
School your child attends: (if
more than one school, please list all)
Required
Grade your child is in: (if more
than one, please list all)
Required
City of Residence:
Required
State of Residence:
Required
Phone:
Optional
Email address:
Required
I would allow my contact information to be
published on a list of all parents who are “taking
action.” This will help you establish a connection with other
parents who share your beliefs about teen drinking.
I would like to
speak with a coalition member to become more informed about how I can
help the community address underage alcohol use. (Please provide your
information above so that we may contact you)
Additional Feedback or Comments:
THANK YOU FOR YOUR PARTICIPATION
IN THE PARENT ACTION CAMPAIGN
Programs & Services 
