Religious Participation Consent

Dear Parent(s)/Guardian(s):

The Caliente Youth Center offers opportunities for youth to participate in on-grounds religious services and activities. Most of these services are non-denominational in delivery, however, there are times when religious leaders from specific denominations visit CYC to offer services. There are also times when we will have the opportunity to participate in off-grounds events at specific places of worship.

The only reason we will deny your child the opportunity of attending, will be if his/her behavior is too disruptive to allow it. We will not force your child to attend any services. If you would like to leave the choice of which church services to attend up to your child, simply mark the appropriate choice below.

Thank you for your assistance. Please write or call us if you have any questions.

Bruce Burgess, Superintendent

Caliente Youth Center

I (we) designate the Church as the church I (we) would like my (our) child to attend while at the Caliente Youth Center.
Name Of Child
My (our) child may attend non-denominational services Yes No
The choice is his/hers to make YesNo
Parent/Guardian Telephone number
Parent/Guardian Name
Parent/Guardian Email
Date Submitted
All Information to be verified by DCFS staff before activation