Adult Chaperone Registration — At the Altar of the King

Adult Chaperone Registration — At the Altar of the King

Parishes and groups must bring 1 adult chaperone for every 10 children. Every chaperone must be 21 or older and have completed (1) fingerprinting through Live Scan and (2) the CMG Connect Youth Protection Certificate for the Diocese of San Bernardino.
Chaperone section
Full Name

First NameMiddle NameLast Name
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Parish
Parish City
Role at Parish
Number of Minors from Your Parish You Are Responsible For
Names of the Altar Servers in Your Group
Safe Environment Compliance section
Chaperones without completed Live Scan fingerprinting and a CMG Connect Youth Protection Certificate may not supervise children at this event. Clearance will be verified with the parish and the diocesan Safe Environment Office.
Where to complete your requirements
• CMG Connect Youth Protection Certificate: sign in or register at sanbernardino.cmgconnect.org
• Live Scan fingerprinting: please ask your parish office for the diocesan Live Scan Request Form. Then find a Live Scan location near you. More info: the diocese's Background Checks page.
• Questions: Diocese of San Bernardino Office of Child and Youth Protection, (909) 475-5125 · childandyouthprotection@sbdiocese.org
Have you completed Live Scan fingerprinting and been cleared by the Diocese of San Bernardino?
Live Scan clearance date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Have you completed the CMG Connect Youth Protection Certificate for the Diocese of San Bernardino?
CMG Connect Youth Protection Certificate completion date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Upload your CMG Connect Youth Protection Certificate

Cancelof
Chaperone Agreement section
I agree to follow the Diocese of San Bernardino Code of Pastoral Conduct and safe environment policies, including never being alone with a minor, staying with my assigned group for the full day, and reporting any concern to retreat staff immediately.
I confirm that the information I provided is true and complete.
Emergency Contact section
Emergency contact name

First NameLast Name
Relationship to you
Emergency contact phone
Please enter a valid phone number.Format: (000) 000-0000.
Signature section
E-signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Adult Chaperone Registration — At the Altar of the King

Chaperone section

Safe Environment Compliance section

Chaperone Agreement section

Emergency Contact section

Signature section