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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.

Please select Minor(s) below and choose how many will be participating...

Adult Minor(s)
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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*

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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*

Type Signature

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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*

Type Signature

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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*

Type Signature

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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*

Type Signature

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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*

Type Signature

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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*

Type Signature

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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*

Type Signature

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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*

Type Signature

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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*

Type Signature

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Parent or Guardian's Email Address

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

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.

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*

Type Signature

Draw Signature

Click to Sign

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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Agree To This Document