Diocese of Colorado Springs > Offices > Child and Youth Protection

INFORMATION ON SIGNS OF CHILD ABUSE

OPTIONS FOR REPORTING ABUSE

RELATED DOCUMENTS

OTHER RESOURCES

PROCEDURES FOR REPORTING SEXUAL MISCONDUCT

If the abuse involves a Priest, Deacon or an employee of the Church, also contact the Office of Child and Youth Protection.

OCYP Director
Deacon Thomas Dickinson
(719) 866-6479

After Hours
Call (719) 866-6505 (English and Spanish)

It is the policy of the Diocese of Colorado Springs to respond promptly and with compassion to all reports of misconduct. Be aware that if you report child abuse and/or neglect, the Diocese will report the matter to law enforcement.

CHILD ABUSE REPORTING FORM

Your Information

Name:
Email:
Title/Role:
Address:
Phone Number:
Would you like to be contacted by a Victim Advocate?:

Yes
No

Child/Youth Information

Name:
DOB/Age:
Address:
School that Child/Youth Attends:
Parent/Guardian:
Contact Information:

Incident Information

Personnel Involved:
Incident Type:
Date of Incident:
Time of Incident:
Location of Incident/Address:
Specific Area at Location (ex. hallway, classroom, playground, etc.):
Incident Description:
Witnesses (if known, include names, addresses, phone numbers, etc.):

Offender/Suspected Offender Information

Name:
Title/Role/Relationship:
Contact Information (Address, Phone Number, etc.):

Reporting Information

Notifications made to (check that all apply):

Child Protective Services
Ministry Leader
Parents
Parish Safe Environment Coordinator
Pastor/Principal
Police
Notification Related Information (ex. police case report number, officer name, etc.):
Parish/School Name:

Report Child Abuse