Safe Environment White

Single Occasion Volunteer Form

Single occasion volunteers should review the documents below and then complete the form that follows.

Safe Environment Key Contacts

Office of Child and Youth Protection
Director
Fiona Laverty, STB, JCL
573-635-9127, ext. 240

Victim Assistance Coordinator
Jacqueline Baldwin
573-694-3199


Alphonse J. Schwartze
Memorial Catholic Center

2207 West Main St
Jefferson City, MO 65109-0914

Step 2: Fill out the online form below

This form, from the Office of Child and Youth Protection, is for people who volunteer once per year at their parish.

Per Section 1.4 of the Safe Environment Policy, these volunteers are not required to participate in a VIRTUS training session but must fill out this form with their electronic signature indicating that they are a single-occasion volunteer who will comply with the Volunteer's Code of Conduct. 

  • MM slash DD slash YYYY
    If you do not consent to this check, you may not be eligible to volunteer. Contact the Office of Child and Youth protection if you desire more information, clarification or have questions.
  • Please type your full name here to act as your electronic signature.