RCS Safe Environment

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Regis Catholic Schools is required to provide the information in this form to the Diocese of La Crosse as part of the Safe Environment program. Please complete the entire form and turn in any additional paperwork as requested to be compliant with the Safe Environment program.

First Name *

Last Name *

E-mail address *

Date of Birth *

YYYY

What is your association with Regis Catholic Schools? *

Classroom Volunteer

Current Paid Faculty & Staff, Paid or Volunteer Coach

New Paid Faculty & Staff, Paid or Volunteer Coach

What is your primary role? *

Administrator

Coach (paid)

Coach (volunteer)

Daycare (Child Development Center)

Substitute Teacher

Support Staff (paid employees only)

Teacher

Volunteer (parent)

Volunteer (community/non-parent)

Other:

Is your primary role?

Paid

Unpaid

Clear selection

Primary Affiliation *

Central Office

Regis High School

Regis Middle School

Immaculate Conception Elementary School

St. James the Greater Elementary School

St. Mary's Elementary School

Regis Child Development Center

Genesis Child Development Center

Coach

RCS Substitute Teacher

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