Faith Formation/School/Youth Ministry Programs

Parent Option (“Opt-Out”) Summary Form 

Please complete and submit this form to the PCYI office within 2 weeks of program implementation. The appropriate number of Opt Out materials will then be mailed to your location for distribution to parents exempting their children from personal safety lessons. Opt Out materials should to be distributed to those parents before the end of the program year. Please see Procedures for Opt Out Materials Distribution, included in the PCYI Resource Book, Section IV Page 10, for details.

Please print  a copy of this completed form before submitting and keep in your records for four (4) years.

 1. Did you have any children/youth formally excused by a parent/guardian from attending the safe environment sessions?     

Yes (If Yes, proceed to number 2.)

No  (If No, proceed to number 4.)

 2. Indicate number of children/youth whose parents signed Parent Option Forms and were excused from safe environment curriculum:  

 3. Indicate the number of households represented by the children on line number 2:

 4. Parish/School name:

Programs represented in data reported on this form (i.e. faith formation, school, youth ministry):      

Parish/School Administrator name:  

Please complete and print a copy of this form for your records before submitting.

Please submit this form within 2 weeks of program implementation

If you have questions, please contact Sharon Tomlin at 651-290-1622 or pcyi@archspm.org