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Home Agreement with My Family

Family Agreement Form

The time may come when I can no longer make the best decisions for the safety of others and myself.  Therefore, in order to help my family make necessary decisions, this statement is an expression of my wishes and directions while I am still able to make these decisions.

I have discussed with my family my desire to drive as long as it is safe for me to do so.

Family Agreement Form

I trust my family will take the necessary steps to prohibit my driving in order to ensure my safety and the safety of others while protecting my dignity.

Submitting this form will also send a copy to you and your added family member's email addresses.