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Parent-Teen Driving Agreement

AAP Safe Driving Agreement AAP Safe Driving Agreement

I, _______________________ , will drive carefully and cautiously and will be courteous to other drivers, bicyclists, and pedestrians at all times.

I Promise:

I promise that I will obey all the rules of the road.

Safety Check Always wear a seat belt and make all my passengers buckle up.

Safety Check  Obey all traffic lights, stop signs, other street signs, and road markings.

Safety Check Stay within the speed limit and drive safely.

Safety Check Never use the car to race or to try to impress others.

Safety Check Never give rides to hitchhikers.

I promise that I will make sure I can stay focused on driving.

Safety Check Never text while driving (writing, reading or sending messages)

Safety Check Never talk on the cell phone---including handsfree devices or speakerphone---while driving.

Safety Check Drive with both hands on the wheel.

Safety Check Never eat or drink while driving.

Safety Check Drive only when I am alert and in emotional control.

Safety Check Call my parents for a ride home if I am impaired in any way that interferes with my ability to drive safely, or if my driver is impaired in any way.

Safety Check Never use headphones or earbuds to listen to music while I drive.

I promise that I will respect laws about drugs and alcohol.

Safety Check Drive only when I am alcohol and drug free.

Safety Check Never allow any alcohol or illegal drugs in the car.

Safety Check Be a passenger only with drivers who are alcohol and drug free.

I promise that I will be a responsible driver.

Safety Check Drive only when I have permission to use the car and I will not let anyone else drive the car unless I have permission.

Safety Check Drive someone else's car only if I have parental permission.

Safety Check Pay for all traffic citations or parking tickets.

Safety Check Complete my family responsibilities and maintain good grades at school as listed here: __________________________________________________________________

Safety Check Contribute to the costs of gasoline, maintenance, and insurance as listed here: ________________________________________________________________________________

Restrictions: 

I agree to the following restrictions, but understand that these restrictions will be modified by my parents as I get more driving experience and demonstrate that I am a responsible driver.

Restrictions - HealthyChildren.org Parent Teen Driving AgreementFor the next _____ months, I will not drive after ________ pm.

Restrictions - HealthyChildren.org Parent Teen Driving AgreementFor the next _____ months, I will not transport more than _______ teen passengers (unless I am supervised by a responsible adult).

Restrictions - HealthyChildren.org Parent Teen Driving AgreementFor the next _____ months, I won't adjust the stereo, electronic devices, or air conditioning/heater while the car is moving.

Restrictions - HealthyChildren.org Parent Teen Driving AgreementFor the next _____ months, I will not drive in bad weather.

Restrictions - HealthyChildren.org Parent Teen Driving AgreementI understand that I am not permitted to drive to off-limit locations or on roads and highways as listed here: __________________________________________________________________________________

Restrictions - HealthyChildren.org Parent Teen Driving AgreementAdditional restrictions: ____________________________________________________________________________________________________________________________________________________________________

Penalties for Agreement Violations:

No Driving Penalty - HealthyChildren.org Parent Teen Driving AgreementDrove while texting (composed, read or sent message or email with phone).​

    • NO DRIVING FOR ______ MONTHS

No Driving Penalty - HealthyChildren.org Parent Teen Driving AgreementDrove while talking on the cell phone (including handsfree or speakerphone).

    • NO DRIVING FOR ______ MONTHS

No Driving Penalty - HealthyChildren.org Parent Teen Driving AgreementDrove after drinking alcohol or using drugs.

    • ​NO DRIVING FOR ______ MONTHS

No Driving Penalty - HealthyChildren.org Parent Teen Driving AgreementGot ticket for speeding or moving violation.

    • ​NO DRIVING FOR ______ MONTHS

No Driving Penalty - HealthyChildren.org Parent Teen Driving AgreementDrove after night driving curfew.

    • ​NO DRIVING FOR ______ MONTHS

No Driving Penalty - HealthyChildren.org Parent Teen Driving AgreementDrove too many passengers.

    • ​NO DRIVING FOR ______ MONTHS

No Driving Penalty - HealthyChildren.org Parent Teen Driving AgreementBroke promise about seat belts (self and others).

    • ​NO DRIVING FOR ______ MONTHS

No Driving Penalty - HealthyChildren.org Parent Teen Driving AgreementDrove on a road or to an area that is off limits.

    • ​NO DRIVING FOR ______ MONTHS


Signatures:

Safety Check​Driver Pledge

I agree to follow all the rules and restrictions in this agreement. I understand that my parents will impose penalties, including removal of my driving privileges, if I violate the agreement. I also understand that my parents will allow me greater driving privileges as I become more experienced and as I demonstrate that I am always a safe and responsible driver.

Driver:​                      

____________________________________________________

​Date:

___________________________

Safety CheckParent Promise

I also agree to drive safely and to be an excellent role model.

​Parent (or guardian):

____________________________________________________

​Date:

___________________________

​Parent (or guardian): 

____________________________________________________   

​Date:

___________________________


Additional Information:

Last Updated
9/19/2018
Source
American Academy of Pediatrics (Copyright © 2018)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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