Archdiocese of Atlanta Office of Child and Youth Protection Parent Notification Form

z-Archdiocese of Atlanta Office of Child and Youth Protection Parent Notification Form

St. Clare’s Faith Formation program will present a sexual abuse prevention program, VIRTUS -Teaching Touching Safety, to our students. This program is provided to us by the Archdiocese of Atlanta and is a part of our ongoing effort to help create and maintain safe environments for all children and youth and to protect all of them from sexual abuse. The scheduled lesson is being offered to all students. As a parent, you have the right to choose whether your student participates in the program. We encourage you to read the “overview”, “parent guide”, and “lesson plan” assigned to your child’s age group to understand exactly what your child will be taught. All these materials are available at http://archatl.com/ministries-services/safe-environment/grades-k-12/safe-environment-lesson-plans/ and entering the Password: V1rtus. Please check complete and submit this form for the 2021-2022 school year.

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How many children are in your family?*
1st Child's Name*
First Last
1st Child's Date of Birth*
MM slash DD slash YYYY
2nd Child's Name*
First Last
2nd Child's Date of Birth*
MM slash DD slash YYYY
3rd Child's Name*
First Last
3rd Child's Date of Birth*
MM slash DD slash YYYY
4th Child's Name*
First Last
4th Child's Date of Birth*
MM slash DD slash YYYY
5th Child's Name*
First Last
5th Child's Date of Birth*
MM slash DD slash YYYY
6th Child's Name*
First Last
6th Child's Date of Birth*
MM slash DD slash YYYY
7th Child's Name*
First Last
7th Child's Date of Birth*
MM slash DD slash YYYY
8th Child's Name*
First Last
8th Child's Date of Birth*
MM slash DD slash YYYY
9th Child's Name*
First Last
9th Child's Date of Birth*
MM slash DD slash YYYY
Check all boxes that apply*
- I hereby grant my approval for my child(ren) to attend the training described in this notice.
- I decline to grant my approval for my child(ren) to attend the training described in this notice; but, I understand that as the primary educator of my child(ren) the church requests that I certify that I have provided such training to my child(ren) within the family by returning this form.
- I will allow the Archdiocese to conduct this training. As the primary educator of my child(ren), I will also attend the presentation with my child(ren) when the presentation is being made.
- I request to review all materials prior to allowing my child(ren) to attend the training described in this notice. I will notify you in writing if my child(ren) will not be attending the training once I have reviewed the material. I will review the materials on-line using the Password: V1rtus at http://archatl.com/ministries-services/safe-environment/grades-k-12/safe-environment-lesson-plans/.
Name of Parent or Legal Guardian completing this form*
First Last
Date*
MM slash DD slash YYYY
Parent/Guardian Email*
Parent/Guardian Cell Phone*