I, __________________________________________, testify to the following:

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·         I will only pursue peaceful solutions to the violence of abortion when volunteering with the 40 Days for Life campaign

·         I will show compassion and reflect Christ’s love to all (abortion facility or Planned Parenthood) employees, volunteers, and customers

·         I understand that acting in a violent or harmful manner immediately and completely disassociates me from the 40 Days for Life campaign

·         I am in no way associated with Planned Parenthood, its affiliates or any abortion provider

While standing in the public right-of-way in front of (abortion facility or Planned Parenthood location):

·         I will not obstruct the driveways or sidewalk while standing in the public right of way

·         I will not litter on the public right-of-way

·         I will closely attend to any children I bring to the prayer vigil

·         I will not threaten, physically contact, or verbally abuse (abortion facility or Planned Parenthood) employees, volunteers or customers

·         I will not damage private property

·         I will cooperate with local authorities

Signature: _________________________________Date:__________________

Address: _________________________________________________________

City: ___________________________ State: _____________ Zip:___________

E-mail: __________________________________________________________

Phone: __________________________________________________________

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From the 40 Days for Life website:

“We encourage a positive, prayerful presence outside abortion facilities to show God’s love and mercy to those who visit and work at the abortion centers. This approach avoids shouting, confrontation with patients and employees, and the use of graphic abortion images.” (www.40daysforlife.com/faq)