Nevada Joint Union High School District

Consent for the California Healthy Kids Survey

2019-2020 School Year


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. 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. If you do not want your child to complete the survey, you must notify your school.

Survey Content. The survey gathers information on developmental supports provided to youth; school connectedness and barriers to learning; school safety; and health-related concerns such as physical activity and nutritional habits; alcohol, tobacco and other drug use; and risk of depression and suicide and perceived sexual orientation.

It is Voluntary. Students who, with your permission, 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 before January 5, 2017.  It will take about 50 minutes to complete and will be administered in the computer lab in room I-12.

Potential Risks. 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 14 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 by WestEd, a public, non-profit educational institution. If you have any questions about this survey, or about your rights, call Suzi Rosas at the district at 530-273-3351 ext. 217.


If you do not want your child to participate, you may contact:

Jamie Danieli, Registrar at 


CHKS Withdrawal Form

By returning this form, I do not give permission for my child to be in the California Healthy Kids Survey.

(Please Print)   My child’s name is:                                                                      Grade:           

Teacher’s name:                                                      ________

Signature:                                                                                                     Date: