Love & Responsibility Location: Mother of GodStart Date: Monday, October 6th at 630pmOccurrence: Every Monday for 5 weeks from 630pm-8pmEnd Date: Monday, November 3, 2025Parent Meeting: TBD Parent Name(Required) First Last Child Name(Required) First Last Parent Cell Phone(Required)Child Cell Phone (If applicable)Parent Email(Required) Child Email(Required) Emergency Contact Name(Required) First Last Emergency Contact Cell Phone(Required)Child Date of Birth(Required) MM slash DD slash YYYY Child Grade(Required) 9th Grad 10th Grade 11th Grade 12th Grade Name of School(Required)Consent(Required) I agree to allowing my child to participate in the sexual education class offered through the Diocese. I release Chaldean Diocese and any of their parishes and its clergy, staff, volunteers, and affiliated instructors from any liability that may arise in connection with the child's participation in this program.Consent #2(Required) I understand that this instruction will be presented in accordance with the teachings of the Catholic Church, emphasizing human dignity, chastity, the sanctity of marriage, and respect for life, and will reflect the moral and theological framework consistent with Church doctrine.Type Name For Consent(Required) First Last Would you like to donate to the Office of Life(Required) Yes No Please type in the amount below(Required) Credit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name Δ
