Prevention Plus Wellness Parent Consent Form Sample

Parent/Guardian Consent Form for Student Participation
Prevention Plus Wellness Program Implementation

Dear Parent/Guardian,

Your child has the opportunity to participate in a Prevention Plus Wellness (PPW) program at school. These programs are designed to promote healthy behaviors and prevent substance use among youth by integrating wellness with prevention education.

Program Overview

Prevention Plus Wellness programs, including SPORT and InShape, are evidence-based and listed on national registries of effective programs. They aim to:

  • Increase motivation to engage in healthy behaviors like physical activity, nutrition, and sleep.
  • Prevent or reduce the use of substances such as alcohol, tobacco, marijuana, and other drugs.
  • Help students set personal health goals and reflect on positive self-images and future outcomes.

What Participation Involves

Students will:

  • Attend one or more interactive lessons led by trained educators.
  • Engage in short surveys to help assess their wellness goals and health behaviors.
  • Complete a personal wellness plan that they may take home to review and update.

Participation is voluntary and students may opt out at any time without penalty.

Confidentiality

No identifying personal information will be shared. All responses from students will be kept confidential and used only for educational or program evaluation purposes in accordance with school and district policies.

Benefits of Participation

  • Improved understanding of healthy lifestyle choices.
  • Greater awareness of how to avoid risky behaviors.
  • Development of self-regulation and goal-setting skills.

 

 

 

Consent Statement

Please complete and return this form to your child’s teacher or school counselor.

☐ YES, I give permission for my child, ______________________________, to participate in the Prevention Plus Wellness program at school.

☐ NO, I do not give permission for my child to participate in the Prevention Plus Wellness program.

Parent/Guardian Name: _______________________________________
Signature: _________________________________________________
Date: _______________
Phone/Email (optional for questions or follow-up): _______________________________

If you have any questions about the program, please contact:
[Insert School Contact Name] – [Phone/Email]
Or visit: https://preventionpluswellness.com

Thank you for supporting your child’s health and wellness!