The Rev. Peter E. Bushnell, Rector



____________________________________________________ (Covenantor)


_______________________________________________________Episcopal Church,

________________________________________ (Rector, Clergy-in-charge and/or warden)

Authority and Purpose

The purpose of this Behavioral Covenant is to promote reasonable safety of all persons in the parish, while maintaining a welcoming place of worship for ______________________ (Covenantor).

This covenant is written in compliance with the Episcopal Church in Connecticutís Policy for Parish Protocols for Inclusion of Registered Sex Offenders ("Policy"). The terms are as prescribed by the Policy.


_________________________ (Covenantor) has met with the Rev.____________________. During this meeting, Policy was reviewed with _____________________ (Covenantor) who acknowledges awareness of the policy and understands its provisions.

________________________(Covenantor) has clearly expressed their desired to comply with the policy to help ensure that ________________________ (Name of parish) is a safe place for all who attend.

The Rev. _____________________ has clearly stated their desire and intention that ______________________ (Name of parish) be a place of worship and continued healing for _____________________ (Covenantor) and that _________________________ (Rector/Clergy-in-Charge) can and will be _______________________ís (Covenantor) pastor, subject to ______________________ís (Covenantor) compliance with this covenant.

Information and Confidentiality

_____________________ (Covenantor) is aware that the Rev. ___________________ (Rector/Clergy-in-Charge) is obligated to notify certain members of the parish of _____________________ís (Covenantor) status as a Registered Sex Offender, per the Policy. ____________________(Covenantor) is aware that, while efforts may be made to keep their status on a need-to-know basis, confidentiality is not promised beyond the sacrament of confession.

Agreement and Covenant

_______________________ (Covenantor) agrees to the following:

1. ______________________ (Covenantor) will always attend worship services and parish activities with ___________________________________________________, (Names of identified monitors/chaperones) who will remain at Covenanterís side at all times (outside of bathrooms).

2. ______________________ (Covenantor) will attend worship services on only the following days and times. These are services when children and youth are least likely to be present.





3. ______________________ (Covenantor) will not initiate contact with anyone under 18 years of age and will actively avoid such contact, including moving to other parts of the building as necessary.

4. If anyone under 18 years of age initiates contact with ______________________ (Covenantor), __________________ (Covenantor) will excuse themselves, and move away as quickly as possible.

5. ______________________ (Covenantor) will disclose to adult church members their status on the registry before meeting and/or visiting with adults in any setting, if those adults have minors in their households or as frequent guests in their households.

6. _____________________ (Covenantor) will not attend events outside of the church building where persons under 18 years of age are invited.

7. If _____________________ (Covenantor) needs to use bathroom facilities at the church, _______________________ (Covenantor) will request that a monitor/ chaperone ensure no minors are in the bathroom with _____________________ (Covenantor).

8. If _______________________ (Covenantor) decides to attend a different church, _____________________ (Covenantor) will notify the Rev. ____________________.


This covenant is in effect immediately upon signature. It will be reviewed every six months by the Rev. _____________________ and wardens.

Violations of the Covenant

By signing, __________________________ (Covenantor) agrees, understands and accepts that violation of any of the provisions of this agreement may result in ______________________(Covenantor) being asked to leave ______________________ (Name of parish) Church by the Rev. ______________________(Rector/ Clergy-in-charge, etc.). [If required by the terms of probation, a violation of this covenant may also be reported to Covenantorís probation officer.] The decisions of the Rev. ___________________ in this regard are to be made in consultation with the Canon for Mission Integrity and Training.


_____________________________ _________________________________

Covenantor Rector/Clergy-in-charge

Date: _______________________ Date: ___________________________


Senior Warden


Senior Warden (Printed Name)

Date: ________________________

Monitors/chaperones names, phone numbers and signatures: