Circle of Grace Opt-Out

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- Diocese of Lafayette-in-Indiana Safe Sacred Children’s Learning Program:
  Circle of Grace Opt-Out Form
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  The U.S. Bishop’s Charter for the Protection of Children and Young People and the safe environment policies of the Diocese of Lafayette-in-Indiana require that all children in our Catholic schools and parishes receive age-appropriate safety training through the Safe & Sacred Children’s Learning Program or Circle of Grace programs on an annual basis.
  
  Parents can review the content of this curriculum by contacting the principal, parish director of religious education or the Office of Catholic Schools or by visiting this page on our parish website. If you choose to withhold your child from participation in any part of the training, please sign this form, specifying the name of your child and grade level from which your child’s participation is to be withheld. We will then assume that you are personally covering this content.
  
  Parent
  
  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.
  
  Number of Children REQUIRED Please fill out this field.
  
  Child 1
  
  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 Level REQUIRED Please fill out this field.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  I understand that the learning content listed here is part of the school’s/parish’s safe environment requirements and I have received the parent information and/or materials.
  
  I do not want my child to participate in instruction at the school/parish covering this content, and I assume my responsibility to teach the content to my child at home.
  I Agree Please select this field.
  
  Electronic Signature REQUIRED
  Please type in your full name, which will constitute your digital signature.
  Please fill out this field. Please enter valid data.
  
  Child 2
  
  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 Level REQUIRED Please fill out this field.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  I understand that the learning content listed here is part of the school’s/parish’s safe environment requirements and I have received the parent information and/or materials.
  
  I do not want my child to participate in instruction at the school/parish covering this content, and I assume my responsibility to teach the content to my child at home.
  I Agree Please select this field.
  
  Electronic Signature REQUIRED
  Please type in your full name, which will constitute your digital signature.
  Please fill out this field. Please enter valid data.
  
  Child 3
  
  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 Level REQUIRED Please fill out this field.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  I understand that the learning content listed here is part of the school’s/parish’s safe environment requirements and I have received the parent information and/or materials.
  
  I do not want my child to participate in instruction at the school/parish covering this content, and I assume my responsibility to teach the content to my child at home.
  I Agree Please select this field.
  
  Electronic Signature REQUIRED
  Please type in your full name, which will constitute your digital signature.
  Please fill out this field. Please enter valid data.
  
  Child 4
  
  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 Level REQUIRED Please fill out this field.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  I understand that the learning content listed here is part of the school’s/parish’s safe environment requirements and I have received the parent information and/or materials.
  
  I do not want my child to participate in instruction at the school/parish covering this content, and I assume my responsibility to teach the content to my child at home.
  I Agree Please select this field.
  
  Electronic Signature REQUIRED
  Please type in your full name, which will constitute your digital signature.
  Please fill out this field. Please enter valid data.
  
  Child 5
  
  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 Level REQUIRED Please fill out this field.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  I understand that the learning content listed here is part of the school’s/parish’s safe environment requirements and I have received the parent information and/or materials.
  
  I do not want my child to participate in instruction at the school/parish covering this content, and I assume my responsibility to teach the content to my child at home.
  I Agree Please select this field.
  
  Electronic Signature REQUIRED
  Please type in your full name, which will constitute your digital signature.
  Please fill out this field. Please enter valid data.
  
  Child 6
  
  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 Level REQUIRED Please fill out this field.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  I understand that the learning content listed here is part of the school’s/parish’s safe environment requirements and I have received the parent information and/or materials.
  
  I do not want my child to participate in instruction at the school/parish covering this content, and I assume my responsibility to teach the content to my child at home.
  I Agree Please select this field.
  
  Electronic Signature REQUIRED
  Please type in your full name, which will constitute your digital signature.
  Please fill out this field. Please enter valid data.
  
  Submit