Safe Environment Application - Youth

COMMITMENT TO THE CODE OF CONDUCT AND AUTHORIZATION FOR YOUTH WORKING WITH YOUNGER CHILDREN
(For volunteers under the age of 18.)

THANK YOU for your interest in volunteering at St. Vincent de Paul Catholic Church. The Diocese of Fort Wayne-South Bend requires that all volunteers working with children or teenagers on a regular basis go through a screening process to ensure the safety of the children and teenagers at our parish.

Please note that completing the application process does not guarantee that you are able to participate as a volunteer with children or teenagers at the parish. If you have any questions, please contact the parish staff member with whom you are volunteering or the parish's Safe Environment Coordinator in the parish office at 260-489-3537.

Please review the Code of Conduct  issued by the Diocese of Fort Wayne-South Bend outlined below prior to completing your application.

Diocese of Fort Wayne-South Bend Safe Environment
COMMITMENT TO THE CODE OF CONDUCT AND AUTHORIZATION FOR YOUTH WORKING WITH YOUNGER CHILDREN
I promise to follow faithfully the rules and guidelines in the Diocese of Fort Wayne-South Bend Code of Conduct for Youth Working with Younger Children as a condition of my providing services to children.
I understand that any action inconsistent with the Diocese of Fort Wayne-South Bend Code of Conduct for Youth Working with Younger Children or any failure to act mandated by the Code may result in my removal from my position of working with children.
I further understand that I may, as a condition of continuing in my position, be required to participate in education and training provided by the parish, school, or diocese.
Name
  •  
Date of Birth //
  •  
Phone --
  •  
Address
  •  
By typing my name below and submitting this application, I certify that I am the person who is applying for the volunteer position on this application form.
Signature of Youth
  •  
Date //
  •  
Parent Information
I am the parent/legal guardian of
  •  
I have received and support the Diocese of Fort Wayne-South Bend Code of Conduct for Youth Working with Younger Children and I have reviewed it with my son/daughter. I understand that the parish/school has a responsbility to provide a safe environment for all its young people. I understand that my son/daughter will need to receive training to qualify to perform the service that is assigned. I certify that I am not aware of any problem with or past conduct on the part of my child which indiates, to any degree, that my child may pose a risk of harm to himself/herself or to others with whom my child may interact as a volunteer for the diocese. I understand that the diocese retains the right, in its sole discretion, to determine whether my child may perform service for the diocese.
Parent/Legal Guardian Name
  •  
By typing my name below and submitting this application, I certify that I am the parent or guardian of the child or teen who is applying for the volunteer position on this application form.
Parent Signature
  •  
Date //
  •  
Email
  •  
Preferred Phone --
  •  
Alternate Phone --
  •  
Emergency Contact
Name
  •  
Phone --
  •  
Relationship
  •  
  •  
 
Online Giving

Online Giving

Secure and Convenient Donate now!