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Diocese of Greensburg
Virtual Classroom Video/Audio Recording

Parent/Guardian Acknowledgment Form

In order to provide continuity of instruction while schools remain closed as a result of the COVID-19 pandemic, the Catholic schools in the Diocese of Greensburg will use a variety of teaching methods, including virtual classroom activities. Participation in virtual classroom activities should be under the supervision of the parent/guardian, and is subject to school policies and regulations as stated in the Acceptable Use Policy of the Diocese of Greensburg (please see your school's website for a link to the Acceptable Use Policy).

I understand that my child’s classroom teacher may conduct virtual classroom activities. Be aware that video, including audio, will be used for teaching purposes, and at times, teachers may record classroom activities for educational use/purposes. The recordings will only be shared within the school setting for students unable to attend the virtual classroom activity in real-time. The recordings will be stored, accessed, and disposed of in accordance with the guidelines established in the Acceptable Use Policy of the Diocese of Greensburg. 

Before a classroom teacher begins recording a classroom activity, the teacher will let the students know that the class is going to be recorded either from an audio and/or video perspective. If a student does not want to be identified in the recording, the student can turn off their webcam and microphone.

If you have questions or need assistance with virtual classroom activities, please contact your child’s classroom teacher or the school principal.

My signature below indicates my understanding and acknowledgment of the potential for video and audio recording of my child during virtual classroom activities.

First Parent's or Guardian's Name

First Name*

Middle Name

Last Name*
First Parent's or Guardian's Date of Birth*
I certify that I am 18 years of age or older
First Parent's or Guardian's Signature*
Second Parent's or Guardian's Name

First Name*

Middle Name

Last Name*
Second Parent's or Guardian's Date of Birth*
Second Parent's or Guardian's Signature*
Third Parent's or Guardian's Name

First Name*

Middle Name

Last Name*
Third Parent's or Guardian's Date of Birth*
Third Parent's or Guardian's Signature*
Fourth Parent's or Guardian's Name

First Name*

Middle Name

Last Name*
Fourth Parent's or Guardian's Date of Birth*
Fourth Parent's or Guardian's Signature*
Fifth Parent's or Guardian's Name

First Name*

Middle Name

Last Name*
Fifth Parent's or Guardian's Date of Birth*
Fifth Parent's or Guardian's Signature*
Sixth Parent's or Guardian's Name

First Name*

Middle Name

Last Name*
Sixth Parent's or Guardian's Date of Birth*
Sixth Parent's or Guardian's Signature*
Seventh Parent's or Guardian's Name

First Name*

Middle Name

Last Name*
Seventh Parent's or Guardian's Date of Birth*
Seventh Parent's or Guardian's Signature*
Eighth Parent's or Guardian's Name

First Name*

Middle Name

Last Name*
Eighth Parent's or Guardian's Date of Birth*
Eighth Parent's or Guardian's Signature*
Ninth Parent's or Guardian's Name

First Name*

Middle Name

Last Name*
Ninth Parent's or Guardian's Date of Birth*
Ninth Parent's or Guardian's Signature*
Tenth Parent's or Guardian's Name

First Name*

Middle Name

Last Name*
Tenth Parent's or Guardian's Date of Birth*
Tenth Parent's or Guardian's Signature*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Student Information

Student's Full Name (First Middle Last) *

Homeroom # or Classroom Teacher's Name *
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 20 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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. By checking here, you are waiving that right. 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. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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