1. If I decide to leave, I will get out of the house by

________________________________________________________________________

2. I will keep my purse and car keys ________________________________________

So I can get to them quickly when I have to leave.

3. I will tell _____________________________________________________________

about the abuse, and ask them to call the police if they hear anything suspicious coming from my house.

4. I will use _____________________as a code word for my children or friends to call 9-1-1 immediately.

5. If I have to leave my home, I will go ______________________________________.

6. If I can’t go there, I will go to ___________________________________________.

7. When an argument starts to begin, I will go_____________________, a room where I can escape to safety, safely.

8. I will leave money, an extra set of car and house keys, a change of clothing, and important papers with____________________________________________________,

Or _____________________________________________________________________

9. I will open a Savings Account by_________________________________________.

and begin saving money each week or month.

10. ___________________________will allow me to stay with them in an emergency.

11. I can leave extra clothes with___________________________________________.

12. I will tell ____________________________________________________________

At church ______________________________________________________________

At work ________________________________________________________________

At school _______________________________________________________________

At the children’s school or day care center, which people have permission to pick up my children, and that the abuser is NOT permitted to do so (If I have sole custody).

13. I will inform _________________________________________________________

A friend________________________________________________________________

Neighbors, and__________________________________________________________

Pastor, minister, etc., that my abusive partner no longer lives with me.

14. I will inform_________________________________________________________

At work, not to accept calls or answer personal questions from the abuser, and not to allow him to visit my workplace.

15. The phone number for the closest shelter is_______________________________

16. Other important phone numbers are ____________________________________

Pastor,_________________________________________________________________

Supervisor,_____________________________________________________________

Friend, ________________________________________________________________

Other,_________________________________________________________________