| STOP SMOKING CONTRACT
Stop smoking contracts are a great way to show that you are serious
about quitting! Just print one out to get started. First of all,
pick a quit day within the next couple of weeks. It could be a time
of special meaning like your birthday or a holiday, or it could
be a time when there are less stressful things going on in your
life! Next, enlist a parent, friend, or another support person to
be there for you along the way!! Then, choose a reward that you
would want to receive for not smoking for 1 month!! Sign it and
keep it close to you!!
Teen participant:
I, __________________________, agree to make every effort to quit
smoking. I will participate in Start Teenquit to gain the
information and skills that will help me to quit. My anticipated
quit date is __________________. Before and some time after this
quit date, I may experience some withdrawal symptoms, such as irritability,
nervousness, headaches, and other physical symptoms. I may be a
little difficult to get along with during this period. I will appreciate
your support and understanding.
Even though I am quitting smoking to improve my own health, it may
help me to be more successful in quitting smoking if we can agree
on a reward or incentive if I am successful.
Parent, friend, or support person:
I, __________________________, agree to assist and support you
in your effort to quit smoking in the best way that I can. I would
like to give you the following reward or incentive if you are successful
in quitting smoking for a period of 1 month: ______________________________.
After 1 month, your reward will be improved health and, hopefully,
a much longer life.
Signatures of commitment:
Teen participant: _____________________________
Date: _________________
Parent, friend, or support person: ___________________________
Date: _________________
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