Statement of Peace

I, ____________________________________________, testify to the following:                                             Print Name

  • I will only pursue peaceful solutions to the violence of abortion when volunteering with the 40 Days for Life campaign
  • I will show compassion and reflect Christ’s love to all (abortion facility or Planned Parenthood) employees, volunteers, and customers
  • I understand that acting in a violent or harmful manner immediately and completely disassociates me from the 40 Days for Life campaign
  • I am in no way associated with Planned Parenthood, its affiliates or any abortion provider

While standing in the public right-of-way in front of (abortion facility or Planned Parenthood location)

  • I will not obstruct the driveways or sidewalk while standing in the public right of way
  • I will not litter on the public right-of-way
  • I will closely attend to any children I bring to the prayer vigil
  • I will not threaten, physically contact, or verbally abuse (abortion facility or Planned Parenthood) employees, volunteers or customers
  • I will not damage private property
  • I will cooperate with local authorities


Signature: _________________________________Date:__________________

Address: _________________________________________________________

City: ___________________________ State: _____________ Zip:___________

E-mail: __________________________________________________________

Phone: (Home/Work/Cell)______________________________________________