Choking Game Victim's Registration

We appreciate your cooperation in showing the true number of youth killed due to participating in the Choking Game.

The Incident Information is extremely important for research to promote education and prevention. All responses are kept strictly confidential unless indicated otherwise at the end of this survey.

We thank you for taking the time to complete this survey.
If you are filling out a printed form, please mail it to
The DB Foundation, PO BOX 351787, Palm Coast, FL 32135
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  • We know how painful it can be recounting some of the details and we wish there was no need to do so. However, the more we understand the details of the children falling victim to this, the better equipped we are to prevent future death and injury.
  • Definition of AEA: Where oxygen flow to the brain is reduced, as by controlled strangulation or suffocation to achieve a heightened climax. Signs of AeA: full or partial clothing removed, arousing paraphernalia near the scene.

  • Sharing the Story

    When people look at all of children, of different ages, creed, color and religion being effected by the Choking Game it sends home a powerful message. We encourage, but never require, you to share your child's story.
  • The DB Foundation will only use this contact info to contact you directly and relay the requesting media's contact information to you. We never sell or share you contact info with anyone.
  • Privacy Policy
    The security and confidentiality of your information is very important to The DB Foundation. The data collected through this survey will be kept private. Respondent identities will not be revealed in any publication or presentation of the results of this survey, and results will only be presented in an aggregated form. The DB Foundation will not disclose or use the names of respondents for non-research purposes unless the respondent grants us permission to do so. Information that you share with us — by sending us e-mails, participating in the survey, or otherwise — will not be sold or provided to outside third parties. We report data obtained through surveys and other means only in aggregate form; for example, by combining your data with other victims data. We will not publish data in any way in which the confidentiality of the survey responses is not absolutely guaranteed. Access to raw data will be tightly restricted to only those individuals directly involved in data analysis. Our staff will not grant access to third parties or otherwise disseminate your data. If you have any questions about these policies, please email us at