| 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:
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