Family Contract

I, _________________________, have decided to work with my student

_____________________, to make a healthy change in our home environment.

Our change is:

I have decided to make a reasonable change in our home environment. I understand that by making the change above I will help my student to be healthier and happier. I promise to work hard to make this change permanent.

__________________________________________ ____________________________

Family member Signature Date

__________________________________________ ____________________________

Student Signature Date

Non-profit Tax ID # 203478467