DIGITAL PLEDGE
In requesting professional consultation and assistance, I understand that to be successful I must be entirely willing to: (initial each line)
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Fill out the times below:
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1
I know my heartfelt commitment is an important part of the process of change. My signature below underscores that commitment. If, in all good conscience, however, I cannot align myself fully with each statement above, I have initialled each acceptable item rather than signing at this time and agree to discuss in detail any reservations I may have.
Signature
Name
*
First Name
Last Name
Date
*
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: