Diocese of Green Bay - March for Life Chaperone Registration and Liability Form
Welcome to the March for Life Pilgrimage! We are so excited to have you join us on this wonderful opportunity.

This form is for CHAPERONES ONLY: adults, priests, and young adults.
This form is the only form you will have to complete to register for the Diocesan March for Life Pilgrimage. No paper form will be needed. Once you submit this form, your spot is officially reserved.

Each group must provide their own adult chaperones. Our safe environment policy requires one adult chaperone (21 and over) per eight minors. Minimally, there shall be one adult chaperone for any male minors and one female adult chaperone for any female minors. All chaperones must be VIRTUS trained and pass a background check through your parish or school group.

All chaperones must be 21 years or older, VIRTUS certified and pass a background check through your parish or school group. Anyone between 18-20 years old are not considered legal chaperones but will be referred to as young adult helpers and must also be VIRTUS certified and pass a background check.

Please know we will be scheduling chaperone meetings. Those dates are TBD.
Dates you should mark on your calendar for attending include:
1. Parent/Student/Chaperone Meeting: Saturday January 11th (9am-11am at St. Mary Catholic Church in Ledgeview)
2. Send-off Mass + Trip check in: Tuesday, January 21st (4pm for check-in; 6pm Mass at St. Mary Catholic Church in Ledgeview)

First Name *
Your answer
Last Name *
Your answer
Email Address (one that you frequently check *
Your answer
Cell Phone Number *
Your answer
I am registering as... *
Required
I am registering as...
If registering as part of a group, what parish or school are you registering under?
Your answer
What attracted you to chaperone this trip? *
Your answer
Are you VIRTUS Certified through your group? *
Home Address of Adult Chaperone *
Street Address, City, Zip Code
Your answer
Home City and Zip Code of Adult Chaperone *
City, Zip Code
Your answer
Adult Chaperone Date of Birth *
MM
/
DD
/
YYYY
Age at the time of the trip: *
Your answer
Size of shirt *
In case of emergency, please contact: *
First and Last Name
Your answer
Relationship of Emergency Contact to You *
First and Last Name
Required
Home Phone Number of Emergency Contact *
Your answer
Cell Phone Number of Emergency Contact *
Your answer
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