Parental Permission Form Script

Instructions to be Read
When Distributing Permission Forms

A
Dear Teacher:
Please read this as you distribute the parental permission forms to encourage
student participation in the 2021 National Youth Tobacco Survey.
Thank you.
Our class has been selected to participate in the 2021 National Youth Tobacco
Survey conducted by the Centers for Disease Control and Prevention. This
survey is designed to focus on tobacco-related beliefs, attitudes, and behaviors,
and exposure to factors that promote or discourage tobacco use. Your
participation in the survey is very important as you represent thousands of
students around the country. Each of you will receive a parental permission
form to take home for your parent or guardian to sign and check “yes” or “no.”
Please bring this form back in three days. You must return this form to take
part in the survey.

IF YOU DO NOT HAVE A SIGNED PARENTAL PERMISSION FORM,
YOU MAY NOT TAKE THE SURVEY.