Canadian Student Alcohol and Drugs Project Management System

www.csads.ca
csads@cci-research.com
1-866-450-4907

Permission Form (Student opt-out)

Please complete this Permission Form ONLY if you DO NOT want your child to take part in the Canadian Student Alcohol and Drugs Survey (CSTADS). If you have multiple children who are being asked to participate in the survey, please complete one form for EACH child you would like to opt-out of the survey. If your child is [ 19 ] or older, they can decide on their own if they want to participate in the survey by either completing this form in advance of the survey, or by declining to participate on the date the survey is administered.

School Name

Teacher Name

Student's First Name

Student's Last Name

Grade Please Select Grade

Parent/ Guardian's First Name Parent/ Guardian's First Name is required

Parent/ Guardian's Last Name Parent/ Guardian's Last Name is required

Please make a selection before submitting. To have your response recorded you must submit the form.

Parent If child is younger than [ 19 ]
NO, I (parent/guardian) DO NOT want my child who is under the age of [ 19 ] to participate in the survey

If student is [ 19 ] or older
NO, I (student) DO NOT AGREE to participate in the survey

I agree that above information that I provided is correct