370 Campus Dr. | Arcadia, CA 91007
Please note: Year 2 students must have completed Year 1 here at Holy Angels.
Please fill out a separate form for each youth.
If “yes”, enclose a copy of the most recent applicable court order(s).
By signing this document, I give permission for my child/youth to participate in this faith formation program, whether conducted onsite or online.
PLEASE NOTE: This page has TWO separate signature lines. Please read and complete each area.
The undersigned parent hereby releases Holy Angels Parish and its staff from any liability in connection with such use.
The parent acknowledges having read this release, having the opportunity to consider and understand its terms, and does hereby execute it voluntarily with knowledge of its significance.
We at Holy Angels are committed to your child’s safety and well-being. The Archdiocese of Los Angeles provides the Empowering God’s Children and Young People© Safety Program as an ongoing effort to educate children and young people through classroom lessons and activities on ways to maintain their safety. It is based on catechetical principles to help them know God loves them and wants them to be healthy and safe.
A VIRTUS facilitator will present the Empowering God’s Children and Young People© Safety Program to our students in April. This year’s lesson topics include The Five Body Safety Rules, Safe and Unsafe Adults, and Internet Safety. Each lesson includes video presentations, classroom discussions, individual and group activities, and a “Take Home Activity” for students to complete with a parent/guardian. We will also present a Summer Safety Lesson at the end of each year. We encourage all parents to read the “Working Together to Prevent Child Sexual Abuse” brochure, which you will receive at the beginning of the year.
Please complete the form below for your child/youth to participate in the program.
I understand that for my child/youth to participate in the Empowering God’s Children and Young People© Safety Program, I need to fill out this Parent Permission Form. I explicitly permit the Empowering God Children and Young People© Safety Program to be presented to my child/youth.
A separate form must be completed for each youth.
IF/WHEN WE ARE ABLE TO HAVE IN-PERSON MEETINGS, WE NEED THE FOLLOWING INFORMATION:
If a parent or guardian can’t be reached in an emergency, please contact:
By signing this form, I understand that the parish does not assume responsibility for the payment of physicians. However, in an emergency, the parish may choose a physician. In an emergency, I give the parish permission to have my child/youth receive medical treatment.
Your time to complete the form is about to expire due to inactivity. Please click "Continue Working" to complete the form and submit, otherwise your changes will be lost.
Your session will expire in 60 seconds.
Your time to complete the form has expired due to inactivity. Please click the button below or refresh the page with your browser and try again.