South Milwaukee Middle School


Our school district is taking part in the Wisconsin Online Youth Risk Behavior Survey in cooperation with the South Milwaukee Health Department. The survey will ask about the health behaviors of 6th through 12th grade students. The survey will ask about behaviors that result in unintentional and intentional injuries, tobacco use, and alcohol and other drug use. It will also ask about sexual behaviors that may result in HIV infection, other sexually transmitted diseases, and, unwanted pregnancies and dietary behavior and physical activity.

Students will be asked to fill out a computer-based questionnaire that takes about 25 minutes to complete. They will take the survey during the regular school day.

Completing this anonymous survey will cause little or no risk to your child. The only potential risk is that some students might find certain questions to be sensitive. The survey has been designed to protect your child’s privacy. Students will not put their names on the survey. Also, no class or student will ever be mentioned by name in a report of the results. Your child will get no benefit right away from taking part in the survey. However, the results of this survey will help children in the future by influencing health and safety programs. We would like all selected students to take part in the survey, but the survey is voluntary. No action will be taken against you, or your child, if your child does not take part. Students can skip any question that they do not wish to answer. In addition, students may stop participating in the survey at any point without penalty.

Please see the other side of this form for more facts about the survey. If your child’s school counselor or principal cannot answer your questions about the survey, call Tom Vogel, Director of Pupil Services, at 414-766-5026.

If you do not want your child to take part in the survey, check the box, sign and date the form that was sent home via the mail last week, and return the form to the school no later than Thursday, October 23, 2014. Signing and returning this form will dismiss your child from taking the survey. If you have no objection to your child taking part in the survey, you should do nothing with this form. Thank you.

YRBS Permission Form


Please click here for instructions on how to access your parent log-in information.