Taking
Charge Agreement
(Please
feel free to print this page and use it initiate to a conversation
with your child)
Parents/guardians
and teens should take the time to review the issues, privileges
and responsibilities associated with driving. State how
each issue will be handled in your household. Then make
an agreement about compliance with that rule. For example:
Issue:
Alcohol and other drugs
Rule:
I will not use alcohol or other drugs. It is against the
law. I will not put my life in danger by riding with anyone
who has used alcohol or other drugs.
Agreement: If I ever
ride in a car with anyone, including me, has used
alcohol or other drugs, I will be allowed to ride only with
my parents/guardian for 6 months.
Issue:
Alcohol and other drugs
Rule: ___________________________________________________
Agreement: _____________________________________________
Issue:
Curfew
Rule: ___________________________________________________
Agreement: _____________________________________________
Issue:
Safety belt usage
Rule: ___________________________________________________
Agreement: _____________________________________________
Issue:
Accidents, tickets or violations speeding, etc.
Rule: ___________________________________________________
Agreement: _____________________________________________
Issue:
Car phones, music, food
Rule: ___________________________________________________
Agreement: _____________________________________________
Issue:
Number of passengers in car
Rule: ___________________________________________________
Agreement: _____________________________________________
Issue:
Driving area limits
Rule: ___________________________________________________
Agreement: _____________________________________________
Signature
of Teen Driver: ___________________________________
Signature(s) of Parent(s)/Guardian: __________________________
Taking
Charge Promise
Teen
Driver/Rider
I
promise to use safe practices such as observing speed limits
and obeying the traffic safety laws. I will not use alcohol
or other drugs, nor will I get in a car where the driver
has used alcohol or other drugs. If I am ever in a situation
where I need a ride home for my safety, I will call a cab,
ask a sober person to drive me, or call you or another family
member to come and get me.
Teen
Driver / Rider Signature:_______________________________
Parent(s)
/ Guardian
I
promise to pick you up if you ever call me for a ride. If
I do not have a car, I will pay for a cab to bring you home.
I further promise not to initiate a conversation about the
incident at that time. I also agree to: use safe driving
practices, drive sober, and find an alternate means home
if I am ever in a situation where the driver is under the
influence of alcohol or drug.
Parent(s)
/ Guardian Signature:______________________________
Please contact the MADD-NH office for any further information.
Together
we can make a difference!
