P. O. Box 137
Dodge City, KS 67801
On _______________ (date), I was presented the Diocesan Policy for the Protection of Children and Young People for the Diocese of Dodge City and the Code of Pastoral Conduct for the Diocese of Dodge City.
I understand that I am personally responsible for reading and abiding by these policies and the standards of behavior contained therein, including any revisions posted on the diocesan website (
http://www.dcdiocese.org/Protectchildren/PGCpage.htm).
Please print your name: _________________________________
Please sign your name: ________________________________
Please give your parish (name and town):
____________________________________________________