Clergy/Religious Registration/Verification

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Clergy/Religious Registration/Verification - Diocesan Form

Vocations Picnic, Thursday, July 20, 2023: 4:00pm - 8:00pm, Christ the King Retreat House, Syracuse

Clergy/Religious Information

Clergy and members of religious order must have attended Safe Environment training and passed a criminal background check within the last 5 years. If you have questions regarding your Safe Environment credentials, please contact the Office of Safe Environment at 315.470.1421 or safeenvironment@syrdio.org.

Title *

Br.

Dc.

Friar

Most Rev.

Mr.

Rev.

Rev. Mr.

Rev. Msgr.

Sr.

First Name *

Last Name *

Date of Birth *

YYYY

Primary phone number *

Email address *

Parish/School *

Specific Food Allergies *

Verification and Signature

I understand that as a chaperone/volunteer for the Diocese of Syracuse, I will adhere to the Diocesan Child and Youth Protection Policy and Code of Conduct at all times. I understand that any action inconsistent with the diocesan Policy, the Code of Conduct or failure to take action mandated by both documents may result in losing the privilege of working with children/youth/vulnerable adults in the Diocese of Syracuse.

I hereby give my consent to the Diocese of Syracuse to photograph, film, videotape and then use, reproduce, and publish said images of me for the purpose of event advertisement and promotion.

I have read the above and agree *

Yes

Electronic Signature *

In place of your signature, please type your full legal name.

Date *

YYYY

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Roman Catholic Diocese of Syracuse. Report Abuse

Forms