Saint Michael the Archangel Catholic Church

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Smart Boundaries & Safety - A Virtus Session for Teens

- Learn and Grow

Dear Parent/Legal Guardian,
Please complete the form below to consent if you will allow your teen to participate in the high school level of Teaching Safety--Empowering God's Children Program at St. Michael Catholic Church on Wednesday, November 20, 2024. This program is being offered annually for young people at the request of the Diocese of Richmond. This form will provide consent for gathering related to this program unless the parent/legal guardian gives follow-up written notification to staff that consent has been withdrawn. Below, you can find an overview of this training series. This year, your teen will experience Lesson 2: Safe Adults, Safe Touches and Special Safe Adults.

Research shows that child sexual abuse prevention is most effective when there is a partnership between parents and leaders, when material is reiterated in a group session setting, and when the training is interactive and activity based. As the primary educators of your children, parents and guardians are encouraged to review the program overview linked below.

There's also the option to teach my teen this session at home. If you would like to take advantage of this, please check the appropriate box in the form below and resources will be sent to you.

Program Overview
This form is not accepting responses at this time.
- Teen's Information
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade REQUIRED Please fill out this field.
- Teen's Information (2nd Teen - if needed)
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Grade
- Parent's Information
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- At-Home Option I would like to receive the information & resources to teach my teen this lesson at home.
- The name below serves as my digital signature attesting to my consent in having my teen attend this program (or in teaching the material at home if the above box is checked).
  I Agree Please select this field.
- Name REQUIRED Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter a date.
Submit

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Phone: 804-527-1037 Fax: 804-527-1039	4491 Springfield Road \| Glen Allen, VA \| 23060	[email protected]
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