Husband and wife agree to attend marital counseling with _______________ (Name of Counselor) beginning no later than ______________ (Date) and continuing for at least ________ (Number) months, in order to further reconcile and strengthen the marriage.


________________________________          _____________________
Signature of Wife                                                Date
 

________________________________          _____________________
Signature of Husband                                          Date


________________________________          _____________________
Signature of Witness                                            Date