AGREEMENT TO WORK TO REBUILD MY FAMILY

We below hereby enter this binding contract on this date:__________,with the effort, trust and faith that we will all try to rebuild our family and work towards maintaining a loving, peaceful home of trust, open communication and mutual respect.

A. The following list includes the FREEDOMS AND PRIVILIGES that __________ will be entitled to during his/her stay within the family residence:

1. Privacy
________ will be entitled to a private key for his/her bedroom. Only he/she will have this key and no one else. The parents agree not to follow, stalk or harass ________, nor shout or intimidate his/her friends.

2. Smoking
________ will be allowed to smoke cigarettes even though he/she knows it is bad for her health. There will be no smoking allowed in the house. The parents will not give ________ money for smoking. However, smoking will be permitted in ________’s bedroom provided a smoke alarm is in his/her room.

3. Work
________ will be permitted to work, initially part time to help support his/her schooling and personal expenses. If ________ decides to work full time, then he/she will be expected to pay a monthly rent. Otherwise as long as ________ is in school no costs will be applied.

4. Safety and Domestic Violence
No one under any circumstances will act with any physical violence whatsoever towards any member of the family.

5. Friends of the opposite sex
________ will be permitted to have a girl/boy-friend (one at a time) while living at home. The identity of this person shall be made known to the parents. If the parents approve of him, then he/she will be permitted access and privileges into the family home. No intimate activity will be permitted in the family home at any time.

If the girl/boy-friend is not approved by both parents, than he/she will not be permitted access to the family home, but ________ will be permitted to date her/him. If the parents are concerned regarding any substance abuse of the girl/boy-friend, than he will be subject to the same rules and conditions as ________.

6. Alcohol
________ will be not permitted to drink alcohol, whatsoever either in or out of the home.

7. Curfew and Going out
While attending school or co-op work this academic year until ______________ agrees to be home by 2:00 midnight on Monday, Wednesday, Thursday and Sunday evenings. ________ will be permitted extended curfew untiull 4:00Am on Tuesday, Friday and Saturdays. ________ MUST call a family member (eg mother or brother to report in IF he/she will be later than the agreed curfew). If he/she is later, THAN he/she must report exactly where he/she is and provide a name and telephone number of whom he/she will be with, to be able to contact in the event of an emergency.

He/she will be honest and tell her parents where he/she is and with whom. He/she must have her cell phone turned on during these times. If he/she is late for whatever reason, than he/she must phone and explain to his/her parents why. Any additional late hours will be deducted from future privileges.

B. The following list of items are the RESPONSIBILITIES that ________ will be obligated to abide while living at the family home.

1. Courtesy, Respect and Foul Language
All members of the household will be expected to act with respect and courtesy towards each other. This includes quiet conversation with no shouting, No foul language and providing the courtesy and respect to each other that all deserve. ________ will be expected to try to listen and communicate with his/her parents and show genuine manners towards them without foul-mouthed language. ________ will NOT use the ‘f-u-c-k’ word in his/her home or parent’s presence, nor will any parent use the Greek equivalent language.

2. Honesty
All members will be expected to be above all honest to each other and not act in a deceptive manner. ________ will not use his/her friends to lie for him/her behalf. If any such deception is discovered, then that friend will be cut off ties from ________, and the parents will be notified.

3. Domestic Housework
________ will be expected to clean his/her room and subject it to once weekly inspection to her parent of his/her choice. ________ will also wash his/her clothes, prepare his/her meals and pick up after him/herself. All meals and detergents will be provided by the parents free of charge.

4. Drugs
Under NO Circumstances will ________ be permitted to use non-prescription recreational drugs of any sort. This includes marijuana, cannabis, THC, hash, mushrooms, cocaine of any sort, ecstasy etc.

5. Blood tests
Because ________ has shown a very severe change in personality recently coupled with anger and mood swings, ________ agrees that he/she will initially subject herself to weekly blood tests for drugs (starting in 2 weeks from the date below (enough time to wash anything/everything out of his/her system). Cannabis, weed, hash, ecstasy and cocaine are known to cause severe changes in personality and affect judgment and demeanor. The results of these tests will be known only to Dr. Bazos, who will act accordingly with ________ alone regarding the results. After 1 month this will be decreased in frequency to every 2^nd week than monthly thereafter as Dr. Bazos sees fit.

C. TERMS OF CONTRACT:
The above contract shall be binding by all parties who sign. This contract will be revisited and modified by the date:_________, whereby the situation will be re-assessed and modified if ________ or her parents wish ________ move out of the home.

If there is a breech of this contract of 3 or more times than it will become null and void.

If this happens, then ________ will make the appropriate arrangements to vacate the family home within 30 days and the parents will cooperate and permit him/her to take his/her personal belongings to his/her new address (e.g. clothes, computer, bedroom, furniture etc.)

Signed

___________________________ _________________________
Patient: Father:

___________________________ _________________________
Mother: Dr. Michael Bazos (witness)