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Registration is Mandatory for all youth involved in Faith Formation / Youth Ministry at St. John the Baptist Parish.  We require family contact information, health concerns, and specific waivers to be signed to leave your child in our care. 

You will need to do a form for each child you register.

ON SITE EVENT CONSENT

I hereby consent to participation for the named child(ren) in the event described above. I understand that if stated, this event will take place on the Church grounds and that my child(ren) will be under the supervision of the designated parish employee on the stated date(s). I further consent to the conditions stated above on participation in this event. In case of emergency, we give permission for our child(ren) to be treat at a hospital and/or by a medical doctor.

In consideration for providing my child(ren) the opportunity to attend formation and parish activities, both my child(ren) and I voluntarily agree to release and agree to hold Saint John the Baptist Parish and Diocese of Greensburg harmless from, and waive on behalf of myself/my child(ren), my heirs, and any personal representatives, any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself/my child(ren) that may be cause by any act, or failure to act of the Parish and Diocese of Greensburg or that may otherwise arise in any way in connection with my child(ren)'s attendance at a parish event to the fullest extent allow by law.

I understand that this release discharges the Parish and Diocese of Greensburg from any liability or claim that I/my child(ren), my heirs, or any personal representatives may have against the parish / diocese with respect to any bodily injury, illness, death, or medical treatment that may arise from, or in connection to, my child(ren)'s attendance at the parish or event.

This liability waiver and release extends to the Parish and Diocese of Greensburg together with its clergy, staff and volunteers.

I certify and represent that I have the legal authority to waive, discharge, release and hold harmless the released parties on behalf of myself and the above-named student(s).


I Agree

Please select who will be participating...
Minor
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PHOTOGRAPHIC RELEASE
PHOTOGRAPHIC RELEASE*
I hereby grant to the Saint John the Baptist Parish and the Diocese of Greensburg, Pennsylvania, and its respective licensees, successors and assigns, the right and permission, with respect to those photographs and/or videos taken of the minor named below on whose behalf I am signing, and with respect to any printed or electronic matter in connection therewith, to do the following: 1. To include such photographs on the Diocese of Greensburg website and/or social media, Saint John the Baptist Parish website and/or social media and on print material 2. To use the name of the minor on whose behalf I am signing, in connection with the foregoing. I hereby release, discharge and agree to indemnify and hold harmless Saint John the Baptist Parish and the Diocese of Greensburg and its legal representatives, licensees, successor and assigns, from all claims and demands whatsoever arising out of or in connection with the foregoing, and waive any right to inspect or approve the same. I hereby certify that I am the above said minor under the age of eighteen years, and hereby consent on behalf of said minor to the use of any of the photographs taken of said minor pursuant to the terms set forth in this Photographic Release, including, without limitation, the release, discharge and hold harmless provisions thereof.
I DO NOT AGREE TO THE PHOTOGRAPHIC RELEASE
Minor's Information

School Attending
Grade Level 2024-2025 *
Home Parish *
SAINT JOHN THE BAPTIST
Epiphany of our Lord, Monessen
Holy Family, West Newton
Saint Anne, Rostraver
Saint Cecilia, Grindstone
Saint Peter, Brownsville
Saint Sebastian, Belle Vernon
Other
Sacraments Received
Baptism
Reconciliation
Eucharist
Confirmation
Does child have a learning disability?*
Yes
No

If you answered YES, please detail the Learning Disability
Does child have a Food Allergy?*
Yes
No

If you answered YES, please detail the Food Allergy
Does child have a Non-Food Allergy?*
Yes
No

If you answered YES, please detail Non- Food Allergy
Does child have a Medical Condition we should be aware of?*
Yes
No

If you answered YES, please detail Medical Condition

Are there any special accommodations that child requires?

Are there any concerns or situations regarding custody that we should be aware of pertaining to the safety/security of this child?

Is there anyone not permitted to pick-up or be with your child?

Beside the parent/guardian listed in this registration, is there anyone who is permitted to pick-up your child?

Youth Cell Number
Do you give permission for us to Text Message youth directly?*
Yes
No
First Primary Parent / Guardian Name

First Name*

Middle Name

Last Name*

Phone*
First Primary Parent / Guardian Age Acknowledgment*
First Primary Parent / Guardian Date of Birth*
I certify that I am 18 years of age or older
First Primary Parent / Guardian Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
Insurance

Insurance Carrier*

Insurance Policy Number*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 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*
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Age Acknowledgment*
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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