Permission to Contact Youth

Permission to Contact Youth Directly

Immaculate Heart of Mary Youth Ministry staff and adults who are in compliance with the Diocese of Youngstown Child Protection policy are permitted to contact the following child, of whom I am the parent and/or legal guardian:

* Indicates required field

Child's Name *

First

Last

My child may be contacted for Immaculate Heart of Mary youth ministry purposes using the following contact methods:

Choose All that Apply *

Email Texting Social Media Telephone

Child's Email *

Child's Cell Phone Number *

I understand that my child will be contacted for Immaculate Heart of Mary youth ministry purposes only. No adult representing Immaculate Heart of Mary youth ministry will contact my child for personal reasons. I understand that I may revoke this permission at any time with a written request to the Immaculate Heart of Mary Director of Youth Ministry. By typing my name below and clicking the submit button, I am giving the permission defined in this form. Please also provide your email or phone number so that we can verify the validity of your consent.

Paren/Legal Guardian Name *

First

Last

Parent/Legal Guardian Email *

Parent/Legal Guardian Phone Number *

Submit