No Circ Pledge

Send your email address to and I will send out the updated, neater text file of this form right away. There are 3 versions: for parents/guardians, expectant parents, and one to be kept on file at the doctors office. Use this form as needed, change it to suit your particular situation, and feel free to distribute it for use by others. ~Monica



and _____________________________________,

parent(s)/guardian(s) of baby named _______________________________________

born on this date________________________________________

do swear on this date __________________________________________, 20______ that I will not consent to having my child undergo the procedure known as circumcision, from this day forward.

Circumcision is the removal of healthy tissue on the tip of the penis known as a foreskin. A foreskin, or prepuce, serves many important functions that I want my child to enjoy the benefits of.

In addition, I also pledge to properly care for my intact son. I will go by the rule of “Intact, don't retract.” I will clean only what is seen. I will not retract my child's foreskin and I will not allow or consent to any medical professional, babysitter or caregiver or any other person to do so as well.

I claim for my child his natural birthright to a whole, intact body.


Parent Signature

Parent Signature


MoonPye said...

FEEL FREE TO USE MY WORDS or change them to fit your particular situation. I wrote this but am giving permission for ANYONE to use it. If you want me to email the text document, send me a note at and I will send one right out to you.