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The Smoke-Free Home Pledge

The Smoke-Free Homes Pledge is open to all Maine families and individuals who choose to set their own rules against smoking in their home to protect their family from the health risks of secondhand smoke. Families who take the pledge and request a smoke-free kit on the next page will receive a kit in the mail containing materials to help them keep their home smoke-free. The kit includes information about secondhand smoke, quitting smoking, stickers, a door decal, and a coloring postcard for kids.

Take the Smoke-Free Home Pledge today!

Pledge today to keep your home smoke-free. By taking this pledge, you are committing to keep your home smoke-free and making your family and home healthier by removing secondhand smoke.

I, , on , pledge to protect myself and others from the health risks of secondhand smoke by keeping my home smoke-free.

Before now, was smoking allowed in your home (by family or visitors)?YesNo

Do you have children under the age of 18 living in the home?YesNo

I live in a(n):Single family houseApartmentCondoCo-opTownhouseMobile HomeOther

If you live in an apartment, multi-unit building or other rental unit, does your building have a written smoke-free policy?YesNo

How did you learn about the smoke-free pledge?

If "Other", enter source below:

The Smoke-Free Homes Pledge is a program from the Smoke-Free Housing Coalition at the Breathe Easy Coalition of Maine.