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Diocese of Greensburg
Virtual Classroom Video/Audio Recording
Parent/Guardian Acknowledgment Form
Revised 7/1/2021

The Catholic schools in the Diocese of Greensburg will use a variety of teaching methods, including virtual classroom activities, in order to provide continuity of instruction in the event of the school building being closed, transportation not provided or as the need arises. 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 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.

Students are not allowed to record class lectures or take any images to aid in their learning, such as screen shots, and share them publicly.  All video and audio from classroom lessons, either virtual or onsite, will be done only by the teacher and shared in our secure learning management system.  The Diocese is not liable for any student’s collection, use, storage, or other action(s) with respect to the information or data they may collect.  Any student who is caught doing this will be disciplined, suspended or dismissed.

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 Age Acknowledgment*
First Parent's or Guardian's Date of Birth*
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*
Parent's or Guardian's Date of Birth*
Date of Birth
Second Parent's or Guardian's Signature*
Third Parent's or Guardian's Name
First Name*
Middle Name
Last Name*
Parent's or Guardian's Date of Birth*
Date of Birth
Third Parent's or Guardian's Signature*
Fourth Parent's or Guardian's Name
First Name*
Middle Name
Last Name*
Parent's or Guardian's Date of Birth*
Date of Birth
Fourth Parent's or Guardian's Signature*
Fifth Parent's or Guardian's Name
First Name*
Middle Name
Last Name*
Parent's or Guardian's Date of Birth*
Date of Birth
Fifth Parent's or Guardian's Signature*
Sixth Parent's or Guardian's Name
First Name*
Middle Name
Last Name*
Parent's or Guardian's Date of Birth*
Date of Birth
Sixth Parent's or Guardian's Signature*
Seventh Parent's or Guardian's Name
First Name*
Middle Name
Last Name*
Parent's or Guardian's Date of Birth*
Date of Birth
Seventh Parent's or Guardian's Signature*
Eighth Parent's or Guardian's Name
First Name*
Middle Name
Last Name*
Parent's or Guardian's Date of Birth*
Date of Birth
Eighth Parent's or Guardian's Signature*
Ninth Parent's or Guardian's Name
First Name*
Middle Name
Last Name*
Parent's or Guardian's Date of Birth*
Date of Birth
Ninth Parent's or Guardian's Signature*
Tenth Parent's or Guardian's Name
First Name*
Middle Name
Last Name*
Parent's or Guardian's Date of Birth*
Date of Birth
Tenth Parent's or Guardian's Signature*
Parent or Guardian's Email Address
Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Student's Full Name
(First Middle Last) *
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.


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*
Relationship*
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 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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