____ Commitment Agreement and Consent for Care, Discipline and Therapeutic Support:
I, “Bear’s Full Name”, hereby commit to being a contributing member of the “Themom” family and agree to voluntarily submit to the care, authority and therapeutic support of my parents, “Hubby’s Full Name”, and Mary Themom, until I am ready to become a healthy, independent, contributing member of society.
____ ____ Commitment to Care and Treatment
We, “Bear’s Full Name”’s parents, “Hubby’s Full Name”, and Mary Themom, have committed to working in the best interest of “Bear’s Full Name”, in helping him become a healthy, independent, contributing member of society capable of developing meaningful relationships. We will do this to the best of our ability, while honoring our commitment to each other and each member of our family.
I acknowledge the importance of participating in family therapy, treatment planning, and transition preparation. I authorize my parents to participate and assist in organizing these activities.
Commitment to Healthy Living
This family has undertaken the task of assisting in the care and treatment of “Bear’s Full Name”. It is vitally important that all Bear’s energy and effort be focused on treatment issues in order for him to progress and to change past behaviors. For this reason, Bear must commit to ceasing (or not starting) any and all activities that could be detrimental to his growth and maturity, including, but not limited to, illegal drug and alcohol use, criminal activities, and sexual activities outside of a committed, monogamous relationship (when ready). He commits to making healthy living choices wherever possible, including, but not limited to; exercise, healthy eating habits, taking his medication as prescribed, reporting and following up on health and hygiene issues, attending school and/or work and therapy.
____I acknowledge the importance of healthy living in achieving my goal of becoming a healthy, independent, contributing member of society, and commit to striving toward achieving and maintaining a healthy mind and body.
____Commitment to being a RRHAFTBALL, Contributing Family Member
I acknowledge the importance of following the family rules, participating in family activities, and contributing to the well-being of the family (including doing chores) and its individual members. I also acknowledge the importance of being RRHAFTBALL (Respectful, Responsible, Attitude, Fun To Be Around, Loving and Learning). I commit to striving toward the advancement of the family and to becoming a fully functioning and contributing family member.
Family Members Responsibilities:
____Commitment to Obey Family Rules, School Policies, Society/Church Moral Codes, and Legal Laws
I acknowledge the importance of following the rules and laws of the family and society in general. I understand that if I am in breach of any of these guidelines and laws, my parents will take appropriate actions which may include, terminating this agreement, committing me to a psychiatric or drug rehabilitation facility or other alternative residential placement, or contacting school or legal authorities. I commit to following these guidelines to the best of my ability and to stay (not run away) and accept any consequences for failure to do so.
____Acknowledgement of Receipt of Behavioral Information, Rights and Grievance Process (The FAIR Club)
I have been provided with a written copy of the Philosophy and Practices of this Family (The FAIR Club), including rules and interventions used. My rights and responsibilities as a contributing member of this family have been reviewed with me until I understand. I have been made aware of the Grievance Process (FAIR Club Committee) should I have concerns or wish to make changes.
____Acknowledgement of Parental Commitment to “Bear’s Full Name”
I understand that my actions, behaviors, issues, or breach of this commitment on my part or that of my parents in NO WAY affects my parents’ love and commitment to me.
____ ____ Commitment to “Bear’s Full Name”
We, Bear’s parents, commit to continuing to love, honor and cherish “Bear’s Full Name”, regardless of his actions or issues, until death do us part.
____ ____ ____Right to Revoke Commitment
We understand that each of us has a right to revoke this Commitment at any time by giving written notice to the other members of this agreement. This authorization will automatically expire or be renegotiated upon Bear’s change of address, serious breach of family rules or criminal activity, or at age 25. The termination of this commitment DOES NOT affect the emotional commitment made on the part of the parties mentioned herein.
POTENTIAL BENEFITS TO MAKING THIS COMMITMENT
1. You my learn more about your physical, emotional, psychological needs.
2. You may be able to avoid future detrimental activities and behaviors and the consequences that would result.
3. You may learn valuable skills that can help you be more honest and open with others –allowing deeper, more meaningful and satisfying relationships in the future.
4. You may learn to recognize and change harmful thought patterns and defense mechanisms.
5. You may learn to handle stress and emotions more effectively.
6. You may get a feeling of accomplishment and increase your self-esteem.
7. You may be better prepared to live a healthy, independent, productive, successful life.
8. You may have the opportunity to help others that have problems similar to your own.
POTENTIAL RISKS TO MAKING THIS COMMITMENT
1. You may find it distressing to recall your past.
2. You may find it distressing to trust others.
3. You may find it distressing to share things about your past that you had kept secret.
4. You may discover how your issues and behaviors have caused problems for you and those around you.
5. When you find yourself repeating old patterns and behaviors, your awareness and understanding of these patterns and behaviors may make future behaviors and interactions distressing.
By my signature below, I agree that I have read (or had read to me) this document. I understand the potential risks and benefits to this commitment and I agree to make this commitment for the benefit of myself and others.
_____________________________________ Date ________________
________________________ __________________________ Date _______