April 2020
Dear Parent or Legal Guardian,

To serve the youth of the Catechetical Ministries in the parish of Saint Lawrence the Martyr in the Diocese of San Jose during the State’s Shelter in Place Orders, Sunday School/Sacramental Prep/Middle School Youth Ministry and High School Confirmation Ministries/RCIA are providing virtual programming and content for its participants, through which staff/volunteer Catechists/Leaders will facilitate program activities through online platforms. The Program will use software, tools and applications provided by third-parties that participants, parents/legal guardians and/or staff will access via the internet and use for purposes of communication and programming and potential content creation. These platforms may include but are not limited to: Facebook, Instagram, Twitter, YouTube, TikTok, GoToMeeting, and Zoom.
This Form provides your consent and release for your child to participate in the Program and utilize
these online applications for distance-based, virtual program purposes. Please be aware that each
application collects different information about its users and has its own privacy terms and conditions to
which members must adhere and which Parish cannot control or assume responsibility. Please review
these carefully before registering your child.
Our commitment to keeping the young people we serve safe is always our number one priority. To that
end, we will actively monitor participant activity. All online activities contemplated hereunder must also
comply with the Diocese of San Jose Safe Environment and Technology Policies including the Code of
Conduct guidelines and the Diocesan Social Media policy.
The DSJ Safe Environment and Technology Policies are provided on the following link:
Please review.
, am the parent or guardian of,
I have received and reviewed the Diocese of San Jose Safe Environment and Technology Policies
including the Code of Conduct guidelines and the Diocesan Social Media policy.I understand that I will have access to everything provided to my child and be made aware of how social media is being used, be told how to access the sites, and be given the opportunity to be copied on all material sent to my child via social networking (including text messages). I authorize and consent to staff or other leaders of the Parish to communicate with my Child electronically, including via social media, text, email and phone in accordance with the Program.
I understand that if any staff or other leaders knowingly communicate privately with my child as a part
of his or her duties for or on behalf of above-named school-parish, reasonable steps will be taken to
send to me the same communication content, though not necessarily via the same technology. I acknowledge that to review or receive public communications shared via social media with my Child, I will need to become a fan or follower of the same social media. I understand that communications or posts may be accessible or viewable by others who are also fans or followers of the same social media. 
I understand that without this consent my child will not be able to participate in the Program.
If I choose to rescind my authorization and consent provided herein, I agree that I will inform the Parish
in writing and that my rescission will not take effect until it is acknowledged by the Parish.
I understand, however, that it may not be possible to recall any work, photos or videos that have been
published as part of the Program prior to receipt of my written rescission.
I have read this Consent and Release Form and have had the opportunity to consider its terms and
understand them. I verify that I have read and voluntarily agree to the terms and conditions of the
Consent and Release Form – Virtual Media for Youth from the Diocese of San Jose.
I further hereby hold harmless, release and forever discharge the Diocese of San Jose and its employees,
agents, licensees and legal representatives from, and shall indemnify them against, all claims, demands,
and causes of action which I, my heirs, representatives, executors, administrators or any other person(s)
acting on my behalf or on behalf of my estate have or may have by reason of my Child’s participation in
the Program and through my authorization, consent and release herein.
I have read this Consent and Release Form, I fully understand it, and I voluntarily agree to be bound by
its terms. I represent and certify that I am the parent or legal guardian of the minor.
I Agree *