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.

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All fields are required.

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