22 - 23 Parent/Guardian Consent Form for the California Healthy Kids Survey (CHKS) 
Dear Parent or Guardian:

Your child is being asked to be a part of our school’s California Healthy Kids Survey (CHKS), sponsored by the California Department of Education (CDE). This is a very important survey that will help promote better health and well-being among our youth, improve the school learning environment, and combat problems such as drug abuse and violence. Your child does not have to take the survey. Participation is voluntary and requires your permission.

Survey Content.
The survey gathers information on developmental supports provided to youth; school connectedness and barriers to learning, as well as behaviors such as physical activity and nutritional habits; alcohol, tobacco, and other drug use; and school safety. You may examine the questionnaire in the school office or at https://sandiegounified.org/departments/counseling_and_guidance/cal-schls . The results from this survey are compiled into the district- and county-level CHKS Reports. To view a copy of our district’s report, go to https://calschls.org/reports-data/search-lea-reports/ and type in San Diego Unified.

It is Voluntary.
Students who agree to participate do not have to answer any questions they do not want to answer and may stop taking the survey at any time.
It is Anonymous. No names are recorded or attached to the survey forms or data. The results will be made available for analysis only under strict confidentiality controls.

Administration.
The survey will be administered on Thursday, March 9th, 2023 in 5th grade Social Studies classes.

There are no known risks of physical harm to your child. Risks of psychological or social harm are very small. None have been reported in 20 years of survey administration. In rare instances, some discomfort might be experienced from the questions. The school’s counseling services will be available to answer any personal questions that may materialize.

For Further Information.
The survey was developed for the CDE by WestEd, a public, non-profit educational institution. If you have any questions about this survey, or about your rights, call Sharon Rubalcava (619.725.7255), Program manager of Counseling and Guidance.
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