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Contact Permission Form

Telephone Consumer Protection Act (TCPA) Compliance

In compliance with the Telephone Consumer Protection Act (TCPA), the Diocese of Greensburg's Office of Information Technologies and Office for Catholic Schools are asking every parent/guardian and faculty member to complete and sign this Contact Permission Form.

  • If you give your permission to be called using automatic dialing equipment, including SchoolMessenger, please choose "Yes" from the permission dropdown box below and provide at least one phone number to which you wish to receive said automatic calls.
     
  • If you do NOT give your permission, please choose "No" from the permission dropdown box below. The phone number(s) you provide will therefore be blocked from receiving automatic calls, including SchoolMessenger.
First Participant's Name
First Name*
Middle Name
Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participant's Permission

Choose "Yes" or "No" from the dropdown box.

Provide at least one mobile phone number.

Phone 1 (555-555-5555) *
Phone 2 (555-555-5555)
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Permission

Choose "Yes" or "No" from the dropdown box.

Provide at least one mobile phone number.

Phone 1 (555-555-5555) *
Phone 2 (555-555-5555)
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Permission

Choose "Yes" or "No" from the dropdown box.

Provide at least one mobile phone number.

Phone 1 (555-555-5555) *
Phone 2 (555-555-5555)
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Permission

Choose "Yes" or "No" from the dropdown box.

Provide at least one mobile phone number.

Phone 1 (555-555-5555) *
Phone 2 (555-555-5555)
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Permission

Choose "Yes" or "No" from the dropdown box.

Provide at least one mobile phone number.

Phone 1 (555-555-5555) *
Phone 2 (555-555-5555)
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Permission

Choose "Yes" or "No" from the dropdown box.

Provide at least one mobile phone number.

Phone 1 (555-555-5555) *
Phone 2 (555-555-5555)
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Permission

Choose "Yes" or "No" from the dropdown box.

Provide at least one mobile phone number.

Phone 1 (555-555-5555) *
Phone 2 (555-555-5555)
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Permission

Choose "Yes" or "No" from the dropdown box.

Provide at least one mobile phone number.

Phone 1 (555-555-5555) *
Phone 2 (555-555-5555)
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Permission

Choose "Yes" or "No" from the dropdown box.

Provide at least one mobile phone number.

Phone 1 (555-555-5555) *
Phone 2 (555-555-5555)
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Permission

Choose "Yes" or "No" from the dropdown box.

Provide at least one mobile phone number.

Phone 1 (555-555-5555) *
Phone 2 (555-555-5555)
Parent or Guardian's Email Address
Email*
Confirm Email*
Student(s) Full Name

If you are a parent, please provide the full name(s) of your child(ren) attending the school.

First Middle Last
First Middle Last
First Middle Last
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Permission

Choose "Yes" or "No" from the dropdown box.

Provide at least one mobile phone number.

Phone 1 (555-555-5555) *
Phone 2 (555-555-5555)
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it.


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