Commitment Contract

Please fill out your Commitment Contract, your results will be downloadable, and sent via email.

Commitment Contract

My Commitment to Stop Using; The CAARE Program

"*" indicates required fields

I hereby commit to and accept responsibility for achieving the goals that I have initialed below. These goals are designed to prepare me to stop getting high. In addition, they show my motivation, confidence, and commitment to the quitting process. I understand that a slip can occur and I must not use it as an excuse to return to use.

1. I will follow the helpful hints and keep in mind what I am experiencing is normal.*

I commit.

2. I will begin to increase my physical activities. I commit to:*

3. I will throw away all of my paraphernalia. (No holding on to anything for old time sake).*

I commit.

4. I will avoid places where there are temptations to get high, such as bars and time with friends who get high.*

I commit.

5. I will drink an extra two glasses of water each day*

I commit.

6. I will reward myself for accomplishing these goals by:*

My Quit Date Is*

My Name*

My Signature*

Today's Date*

This field is for validation purposes and should be left unchanged.

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