Drug Free Kids Club Pledge Form

I CHOOSE not to drink alcohol, smoke, use or experiment

with any other drug not prescribed by my doctor.

Please indicate whether you are a boy or a girl in the gender space below.

Please enter your date of birth in the space below in the following format - DD/MM/YYYY.

Please enter the first and last name of the person who invited you to be a member in the space below. If no one invited you, enter NONE.


(Please enter the text in the image above. Text is not case sensitive.)
Click here if you cannot recognize the code.

All fields are required.

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