Family Media Agreement Template: Print or Copy Free
Use this free, no-signup template to agree on one part of your family's recreational screen use. Fill it in together, print it, or copy the plain-text version into a note. It records a starting plan, not a universal time limit or a promise that every screen ending will be easy.
Created by Parent Reset Co. · Published October 6, 2026
How to use it
- Choose one routine, such as a video after school or a game before dinner. Ask your child what makes stopping and switching activities hard.
- Write a clear stopping point and a possible next activity. Name the adult help that activity needs.
- Include the adults' own device promise. Keep school, communication, medical, and disability-support uses available according to your family's needs and care guidance.
- Try the plan, then review it on the date you wrote down. Change anything that does not fit.
To print: use your browser's Print command. Only the agreement below is formatted for a single US Letter page; you can choose “Fit to page” for A4.
Our family media agreement
Choose one recreational screen routine. Fill this in together, then review it on the date below. Needed school, communication, medical, and accessibility uses stay available.
Family members
Date we start / date we review
The screen use we are planningWhich game, video, or other activity? When does it usually happen?(e.g., one TV episode after school)
What we will choose before it startsContent, device, or an agreed option(e.g., one chosen game)
When this screen time endsA clear event or time; include time to save a game(e.g., when credits roll)
Screen-free time or place we will tryAdults and children discuss the same rule(e.g., no screens at dinner)
Where the device goes afterwardInclude an exception if a needed device must stay close(e.g., kitchen shelf)
What happens next, and who can helpChoose something possible with the time, space, and adult attention available(e.g., read together for 10 minutes)
The words we will use when it is time to stop(e.g., “Time to stop; I’ll help”)
What the adults promise to doFor example, follow a phone-free meal rule too(e.g., phones away at dinner)
Needed-use exceptions or support needsSchool, family calls, medical or disability-support use, work, or another essential need(e.g., schoolwork stays available)
If the day changes, we will explain the new plan this way(e.g., stop before dinner)
Names or signatures after we have talked
At our review, we will ask: Was the stopping point clear? Was the next activity possible? Did the adults keep their part? What should we change?
Copy the text instead
Select and copy this version into a note, message, or document. You can replace any line that does not fit your family.
OUR FAMILY MEDIA AGREEMENT Family members: __________ Start date: __________ Review date: __________ The recreational screen use we are planning: __________ What we choose before it starts: __________ When it ends (including time to save): __________ Screen-free time or place we will try: __________ Where the device goes afterward: __________ What happens next, and the adult help available: __________ Words we will use when it is time to stop: __________ What the adults promise to do: __________ Needed-use exceptions or support needs: __________ If the day changes, how we will explain the new plan: __________ Names or signatures after talking together: __________ At our review, we will ask what worked and what needs to change.
This is a planning tool, not a medical recommendation. Families can choose different routines and exceptions. If a device is part of a child's care or disability-support plan, follow the guidance of their care team. The American Academy of Pediatrics encourages families to discuss media habits together and revisit the plan as needs change; this is Parent Reset Co.'s independently created template, not an AAP form or endorsed program. Read the AAP's family media plan guidance.
Need an example?
See our filled-in family media agreement example for ideas about what to write. If you prefer a designed PDF worksheet, you can also request our free printable by email. The page explains the optional email signup.