Safe Environment May Report Form

DIOCESAN CHARTER COMPLIANCE - SAFE ENVIRONMENT OFFICE MAY REPORT

In order to comply with the implementation of the Charter for the Protection of Children and Young People, programs and events
must be recorded by Catechetical Leaders and Catholic School Principals in the following manner:

Name/Location of Parish or School:(*)

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PROGRAM/EVENT	DATE(s)	GRADE(s)	# Students	# Parents
CURRICULUM (mandated NYS)
**NYS Child Health Safety Program (please fill in grade(s) and number of students at the end of this line)	9/1/24 – 6/30/25			NA





CURRICULUM (additional curriculum, if used)


OTHER SAFE ENVIRONMENT ACTIVITIES (list below)




Family Internet Safety Pact, Distributed, Applies to Parish Religious Education Programs ONLY.

Number of parents who refused to participate, if any:(*)

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(AUDIT PURPOSES ONLY)

**This program is mandatory in all Public and Catholic Schools.

Affirmation(*)

I affirm that the above is true to the best of my knowledge.

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Date(*)

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Your Name:(*)

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Your Email:(*)

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A copy of this form will be emailed to the email address you listed above.

Roman Catholic
Diocese of Ogdensburg

PHYSICAL ADDRESS

MAILING ADDRESS

CONTACT

SOCIAL MEDIA

HOURS