Diocese of Ogdensburg

The Roman Catholic Church in Northern New York

Diocese of Ogdensburg Chaperone Registration Form

Chaperones must complete and submit the Diocesan Chaperone Registration Form. All Chaperones must be 21 years or older, VIRTUS trained and background checked. All Chaperone Registration forms will be reviewed by the Director of Save Environment. Please select the event you would like to chaperone from the drop-down menu.

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Vehicle Information
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Vehicle Insurance
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By eSigning my name above, I acknowledge that in the event of an accident while transporting children, vulnerable adult(s) or youth during an Diocese of Ogdensburg event, any claims will be tendered to my personal automobile insurance company, and my insurance is primary.

Vehicle Inspection
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By eSigning my name above, I hereby affirm and certify that the information provided in the vehicle inspection section is true and accurate to the best of my knowledge.

License Information
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By eSigning my name above, I certify that the above information is true and accurate to the best of my knowledge. I will not seat any child under the age of twelve (12) or a small person in the front passenger seat. I hereby give my permission for a copy of my personal Driving Record Information (MV-15C) to be ordered and used in consideration of my transporting minors during the Diocesan event.

Code of Conduct for Adult Volunteers
By eSigning my name below, I promise to strictly follow the rules and guidelines in the Code of Conduct for Adult Volunteers as a condition of my providing services to the children, vulnerable adult(s) and/or youth of our diocese. I understand that as a volunteer working with children, vulnerable adult(s) and/or youth, I am required to attend VIRTUS training and to have a thorough background check including criminal history. I understand that any action inconsistent with this Code of Conduct for Adult Volunteers may result in my removal as a volunteer/chaperone with children, vulnerable adult(s) and/or youth.

As a volunteer, I will:
• Treat everyone with respect, professionalism, patience, integrity, courtesy, dignity and consideration, using positive reinforcement rather than criticism when working with children and/or youth.
• Consider a vulnerable adult(s) who habitually lacks the use of reason equivalent to a minor.
• Avoid situations where I am alone with children and/or youth at Church activities.
• Refuse to accept expensive and/or inappropriate gifts from children and/or youth or their parent/guardian without prior written approval from the pastor/administrator.
• Refrain from giving expensive and/or inappropriate gifts to children and/or youth without prior written approval from the parents/guardian and the pastor/administrator.
• Report suspected abuse to the vicar/pastor, administrator or appropriate supervisor.
• Cooperate fully in any investigation of abuse of children, vulnerable adult(s) and/or youth.
As a volunteer, I will not:
• Smoke or use tobacco products in the presence of children, vulnerable adult(s) and/or youth.
• Use, possess, or be under the influence of alcohol at any time while volunteering.
• Use, possess, or be under the influence of illegal drugs at any time.
• Engage in sexual intimacies with the persons counseled. This includes consensual and nonconsensual contact, forced physical contact, sexting and inappropriate sexual comments.
• Use, possess, purchase or give pornographic material to a minor.
• Use physical force, humiliate, ridicule, threaten, or degrade children, vulnerable adult(s) and/or youth.
• Touch a child, vulnerable adult(s), and/or youth in a sexual or other inappropriate manner.
• Use any discipline that frightens or humiliates children, vulnerable adult(s), and/or youth.
• Use profanity in the presence of children, vulnerable adult(s) and/or youth.

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