No Circ Pledge for Expectant Parents

I have no idea why it won't paste properly on the blog but if anyone wants the "cleaned up" version please feel free to send me your email address and I'll get it out to you right away. Let me know if you want all 3 versions or just one: for expectant parents, for parents/guardians, for doctors.

NO CIRCUMCISION PLEDGE

_______________________________________

and _____________________________________,

parent(s) or legal guardian(s) of baby

due to be born _______________________________________

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

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, caregiver or any other person to do so as well.

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

Signed,

Parent/Guardian Signature

Parent/Guardian Signature

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