As a future member of the Johnson Spectrum Alliance, I will make an effort to attend meetings whenever possible as well as participate

in the events that the club organizes. Also I will • • • • • • • Have respect and tolerance for my classmates, no matter their orientation or gender identity. Listen to my club members, with an open mind and without judgment. Set a positive example for my family and friends. Work for tolerance in my own community. Speak out against hate and injustice. Make beneficial contributions to my community. Uphold the Safety Contract.

Safety Contract: As a member of the Johnson Spectrum Alliance, I understand that in order for the QSA to

create an effective safe haven for individuals that normally face discrimination, an atmosphere must be created that promises confidentiality and non-judgment. Therefore, I pledge that I will not reveal any of what is said during the meetings by fellow members to anyone who is not already an Alliance member. I will not reveal names of members or whether a student “is or is not” a member of the Alliance unless that member has explicitly given permission for other members to do so, to any person who is not already a club member.
Please return this form to Ellen Pennington, Marielle Gaspar, or Kelsey Wickerham.

Printed Name ___________________________ Grade __________________

Student Signature ___________________________ Date __________________

Parent Signature ___________________________ Date __________________