Pledge

In order to claim my right to: ·         Fulfill my life goals

·         Achieve real, committed love

And, my right to be free from:

·         Emotional damage from dishonest relationships

·         AIDS and other sexually transmitted diseases

·         Teen pregnancy and premature parenthood I, ________________________________________, do hereby pledge that I will remain sexually pure until I marry. I understand that this commitment includes not only technical virginity, but all other areas of physical or sexual involvement which I know in my heart are against my own conscience and well being. I shall make it my goal to keep my mind and body (physically and mentally) sexually pure.

I also commit to remain totally drug free, including all forms of alcohol, tobacco, illicit drugs and inhalants.

I further understand that it is my obligation to have a positive influence on my peers and to be a living example of this commitment. Therefore, to the very best of my ability, I will strive to be A POSITIVE ROLE MODEL.

I will ask _________________________________                                               (_____________________)
             (Name of parent/guardian/adult you will be accountable to)                ( Signature of parent/guardian/adult)

to support me in these commitments, and

I will also ask _________________________________ to support me in these commitments.  
            (Name of ULTRA Teen Choice Staff member or STAR Guide Mentor that you will be accountable to;  leave blank if you don’t know yet)

Signed ________________________

Date __________________________

Please check one: 

First Time Pledge:                    Re-Pledge: