I ____________________ (print your name)
Declare that I
WANT_______________________
So that I can Be, Do and Have the following
OUTCOMES___________________
I acknowledge that there will be
OBTACLES such as_______________
As I live my
PASSION by___________________
But I will take
ACTION by ___________________
And celebrate my
SUCCESS by___________________
I solemnly promise to
SUPPORT myself through this process by ______________________ ____
SIGNED:_____________________
DATE:__________
WITNESSED BY:________________
DATE: ___________