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

Safe Environment Coordinator
Vicki McElwaine
573-635-9127, ext. 252

Alphonse J. Schwartze
Memorial Catholic Center
2207 West Main St
Jefferson City, MO 65109-0914

For your reference

If you would like to read the Safe Environment Policy to clarify your volunteer role, you can download it by clicking here.

Step 1: Read and Review the Volunteer Code of Conduct

Click here to download the Volunteer Code of Conduct to read and review.

Step 2: Fill out the online form below

This form for 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 Code of Conduct.

Select your parish from the list below.*
Your Name:*
First Last
Your Birth Date:*
MM slash DD slash YYYY
Your Email*
Your Address:*
Street Address Address Line 2 City State ZIP Code
Your Phone Number:
Per Section 1.4 of the Safe Environment Policies of the Diocese of Jefferson City, the Office of Child and Youth Protection will complete a check through the National Sex Offender Registry. Please check the box below to indicate your consent to run this check in order to be eligible to volunteer at your parish.*
- Yes, I consent to the Office of Youth and Child protection running the check through the National Sex Offender Registry using my information provided above.
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.
I have read the Volunteer Code of Conduct and verify with my electronic signature below that I am a single-occasion volunteer, defined by Section 1.4 of the Code of Pastoral Conduct.*

Please type your full name here to act as your electronic signature.