NO Circ Pledge with optional doctor acknowledgment

I wrote this for someone this morning. Please feel free to copy and use it. I am freely giving permission for anyone to use my words and share it with anyone who is interested in signing a pledge for their son. You may make modificiations according to your particular situation. With a few changes this could be also written for a daughter. If anyone wants the original text file emailed to them, please drop me a note at intactivist.net@gmail.com and I will send one right out to you. I made two versions, one with a space for doctor's signature indicating they have received a copy to keep on file in the doctor's office.

NO CIRCUMCISION PLEDGE

I, _______________________________________

and _____________________________________,

parent(s) of baby named _______________________________________

born on this date________________________________________

do swear on this date __________________________________________, 20______ that I/we 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/we want my child to enjoy the benefits of.

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

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

Signed,

Parent Signature

Parent Signature

Physician's signature indicating this document is on file for this child:

Physician Signature Date

No Circ Pledge

Send your email address to intactivist.net@gmail.com 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

NO CIRCUMCISION PLEDGE

_______________________________________

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.

Signed,

Parent Signature

Parent Signature

Mama's Boy, a poem for an intact boy

Mama's Boy

by Jill Galano © 2011

just fresh from my mommy's womb, not even a few hours old

the nurses came to ask about circumsion, though mommy had already told them no.

they asked several more times just to be sure, maybe mommy did not make it clear

she said no once again, and hoped that was enough because there was no way

she would hand me over and let them take me away

away to be cut with a very sharp knife, on my tender newborn baby skin ~

especially for no reason at all, except for the fact its been done many times over the years,

and to say no is just simply something many are not strong enough to do,

but they would probably change their minds really fast if they could hear the screams coming from their precious

baby boys, and see the downpouring of tears.

how could it be that this is ok? that doctors and nurses cut babies each day

yet Mothers who say NO! they mock and turn their heads away?

And for those who are not educated, surely you must know that they are cutting precious babies

each and everyday, offering no reasons that make any sense, yet you still hand your babies over and say OK?

so thankful my mommy knew from the start, that nobody, nowhere would be able to change her heart~

I am her precious baby boy, made perfectly from head to toe ~ one day I will thank her for loving and protecting me always,

and from my first day of life, being strong enough to tell them NO!.