Parent/Guardian Name *

First Name

Last Name

Emergency Contact Name *

In the event a parent cannot be reached, please provide us with an alternative contact.

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

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*

I have been made aware of the Safe Environment Social Communications Policy for the Diocese of Green Bay and any related local practices and guidelines concerning social communication. Permission for ministry representatives to digitally communicate with your child/children...

Yes, I authorize communication with my child/children electronically, including via social media or other digital means, in accordance with the diocesan policy listed above by staff ministry representatives.

No, I do not authorize communication with my child/children electronically.