Safe Homes User Form

SAFE HOMES Pledge

ª I will actively supervise all gatherings of youth in our home or on our property, or ask another responsible adult for help to do so.

ª I will not allow the possession or use of alcohol, tobacco, or other drugs by youth in our home or on our property.

ª I will set expectations for my children by knowing where they are going, whom they are with, what they are doing, and when they are to return home.

This is not a legally binding contract, but rather an agreement between members of the SAFE HOMES Parents Network.

SAFE HOMES Pledge Form

This SAFE HOMES Parents Network website serves the counties of Cass, Dodge, Douglas, Sarpy, and Washington in Nebraska.

Parent/Guardian:
Address:
City: State: Zip:
Phone(Home With Area Code): (Work With Area Code): (Cell With Area Code):
Email:
Check here if you would like to be a SAFE HOMES Parents Network Leader.
Check here if you DO NOT want your address published.

Spouse/Guardian #2: (If Different)
Address(If Different):
City: State: Zip:
Phone(Home With Area Code): (Work With Area Code): (Cell With Area Code):

IMPORTANT: After submitting your registration, an email from Safe Homes will be sent to the email address you have supplied. This email will contain a user confirmation web page address that you will need to visit in order to complete your user registration. If you use spam/junkmail filtering, you may need to whitelist "noreply@safehomes.org" and/or check your junkmail folder for this important email.