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approximately 2 Sundays per month
Schedule will be sent via Flocknote after registrations are received
4-5:30 p.m. for 6th-8th Graders and 6:30-8 p.m. for 9th-12th Graders
at Our Lady of Grace Church 

To keep a safe and fun environment for everyone, and for minors to be left in the care of staff and leaders of Our Lady of Grace & Saint Benedict, it is mandatory for us to have everyone's contact information, health concerns, and signed waivers on file.
A family may registerall of their Teens on one waiver. 

Registration is required for participation in Youth Ministry.

NAME OF THE MINISTRY: Youth Ministry

DATES OF THE MINISTRY: 
schedule will be sent to those who are registered

SITE & ADDRESS WHERE THE MINISTRY MEETS: 
Our Lady of Grace Church
1011 Mount Pleasant Road, Greensburg, PA 15601

ON-SITE MINISTRY SUPERVISOR: 
Emily Weaver, Assistant for Discipleship & Evangelization 
or
Katrina Coleman, Director of Discipleship & Evangelization
and/or approved
Parish Staff and Core Team

CONTACT INFORMATION:  724-838-9480

TRANSPORTATION: NONE

FEE: NONE (extra events and retreats may have a fee associated with them)


ON-SITE EVENT CONSENT

I hereby consent to participation for the above-named teen(s) in the ministry described above. I understand that this ministry will take place on the Church grounds and that my teen(s) will be under the supervision of the designated parish employee/volunteers on the stated date(s). I further consent to the conditions stated on this waiver for participation in youth ministry for the entirety of the catechetical year.  In case of emergency, I/we give permission for our teen(s) to be treated at a hospital and/or by a medical doctor.

In consideration for providing my teen(s) the opportunity to attend youth ministry and parish activities, both my teen(s)and I voluntarily agree to release and agree to hold the PARISH/ES AND DIOCESE OF GREENSBURG harmless from, and waive on behalf of myself/my teen(s), 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 teen(s) that may be caused 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 allowed 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/ES, 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.

I Agree


VIRTUAL GATHERING CONSENT IF NEEDED 

I/We, the parent(s)/guardian(s) do hereby give our permission for my/our teen(s), if necessary due to snow, illness, facility issues, or other matters preventing in person gatherings, to attend VIRTUAL YOUTH MINISTRY SESSIONS for the 2026-2027 Catechetical Year if necessary. 

INTRODUCTION
This Policy, and any subsequent policies, is designed to make virtual learning available for parish faith formation and youth ministry communities and promote the responsible and safe use of resources. Cooperation and adherence to this Policy is a condition of access to the aforementioned resources. Violation of this Acceptable Use Policy will result in disciplinary action, which may include removal of access or other applicable consequences, and may have significant legal and/or financial consequences.

ACCEPTABLE AND UNACCEPTABLE USE
The Internet offers the capability for teens and catechists to access and share information on a global scale. The scholarly use of the Internet can provide our teens and catechists with a worldwide, diverse array of resources.

Users will observe the following practices and precautions during virtual learning and online live classroom meetings to help ensure that the use of technology is a safe, productive, and educationally rewarding experience:

  • Teens are expected to be on time, appropriately dressed and seated in an appropriate manner for learning.
  • Teens should be respectful at all times of the catechists and others in the virtual classroom.
  • Teens' screens must use correct names and appropriate backgrounds.
  • Teens will remain active, engaged, and visible at all times, face to face.
  • Teens will remain on mute and only unmute when asked to do so
  • Teens with questions use “raise hand button.”
  • Teens and families may not share the link to the “virtual” classroom with others.
  • Teens agree to the following practices to ensure personal safety and well-being:

During virtual faith formation, the user agrees to:

  • never transmit personally identifiable information (name, age, gender, social security number, address, phone number, credit/debit card information, and the like) of himself or herself, as well as that of any other person.
  • never arrange for a face-to-face meeting with any person at any time during virtual faith formation. Teen users will not agree to meet with someone they have met online without their parents' full approval and participation.
  • notify faith formation personnel immediately if he or she is asked for personal information, views inappropriate materials, or in any other way feels violated, harassed, uncomfortable, or accosted through the use of the parish technology resources.
  • Users agree to the following statements regarding illegal/unauthorized activities and system security:
  • to access only the Internet and network resources, software and/or hardware provided expressly by the parish for educational purposes.
  • to follow the procedures and best practices recommended by parish personnel or system administrator. These procedures and practices may address respect for the resource limits of the parish, personal safety issues, and/or access to appropriate materials.
  • to never to use or respond to inappropriate, obscene, profane, rude, inflammatory, threatening, or disrespectful language.
  • to never to post false information or engage in personal, prejudicial, or discriminatory attacks.
  • to at no time unlawfully harass, intimidate, haze, or bully (which includes cyberbully) another person through the use of any parish online resources.
  • never to access, possess, transmit, retransmit or respond to any information containing sexually oriented material.
  • never to use parish technology resources to engage in any illegal, criminal activity or any conduct which is morally inappropriate and/or violates Catholic teachings. The parish will cooperate fully with local, state, or federal officials in any investigation related to any illegal activities.

Liability:
The Diocese of Greensburg, its parishes, its employees, and its faith formation volunteers will not be held responsible for the actions of a user who is in violation of any of the terms of this policy. This responsibility is extended to, but not limited to: loss or unavailability of data or interruptions of service, violations of copyright restrictions, the accuracy or quality of information obtained through the parish's system, or any liability, damages, or financial obligations arising through the unauthorized use of the parish and/or personal technology resources.

Warranties:
The Diocese of Greensburg, its parishes, its employees, and its faith formation volunteers makes no warranties of any kind, whether expressed or implied, for the service we are providing.

The Diocese and Parish will not be responsible for the accuracy, quality, or usefulness of information obtained through network connections.

The Diocese and Parish will not be responsible for any information that may be lost, damaged, or unavailable due to technical or other difficulties.

The Diocese and Parish will limit individual user network storage/disk space specific to the needs/responsibilities of the user.

The Diocese and Parish will not be responsible for the contents of any website bearing their name(s) unless the web page has been authorized by the administration of the Diocese.

The parish administration reserves the right to establish rules and regulations regarding the use of the system.

PARENT/GUARDIAN PERMISSION TO ACTIVATE USER PRIVILEGES
I certify that I have read the terms and conditions in the Diocese of Greensburg Faith Formation Acceptable Use Policy and discussed them with my child. I understand that access to the Internet, technology, and communications systems are designed for educational, security, and safety purposes and that my teen has agreed to abide by the Diocese of Greensburg usage rules. I understand that my child has responsibility for his or her actions in regard to the use of technology resources and recognize my responsibility for governing and guiding access during virtual learning. I also understand that the consequences, as stated in the policy, for inappropriate actions or conduct. I recognize that it is impossible for the Diocese and Parish to restrict access to all controversial materials, and I will not hold the Diocese and Parish, or their personnel responsible for material acquired or viewed through technology resources. I hereby give my permission to activate any faith formation technology privileges for my child

I Agree


PARENT/GUARDIAN PERMISSION FOR RECORDING OF VIRTUAL CLASSROOM MEETINGS

I understand that live virtual meetings that take place will be recorded for teen safe environment purposes. These recordings will not be published or shared with anyone except with proper personnel in the instance that safe environment.is called into question.

I Agree

PHOTOGRAPHIC RELEASE
I hereby grant to Our Lady of Grace and Saint Benedict Parishes, Greensburg, Pennsylvania, and their respective licensees, successors and assigns, the right and permission, with respect to those photographs 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: To include such photographs on the Our Lady of Grace and Saint Benedict website, social media, and on print material (names of minors are not used for web or print media/publications without prior consent) I hereby release, discharge and agree to indemnify and hold harmless 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 parent and/or guardian of the above said minor/s 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.*
First Teen's Name
First Name*
Last Name*
First Teen's Date of Birth*
Date of Birth
Information
Teen's Cell Phone # for Flocknote (if they do not have their OWN cell, please enter NONE; do not re-enter a parent's number) *
Teen's Email for Flocknote (if they do not have their OWN email, please enter NONE; do not re-enter a parent's email) *
School District Attending*
Grade for 2026-2027*
My parish of registration is*
My teen has been baptized*
Yes, in the Catholic Church
Yes, in a non-Catholic Church (has not been brought into the Catholic Faith)
No
No, but is interested in being baptized
My teen has received the Sacrament of the Eucharist (1st Communion)*
Yes
No
No, but is interested in receiving the Sacrament
My teen has received the Sacrament of Confirmation (Chrismation for the Eastern Rite)*
Yes
No, Is younger than the normative age (6th & 7th graders)
No
No, but is interested in receiving the Sacrament

ANSWERS TO THE FOLLOWING QUESTIONS ARE OF A SENSITIVE AND PRIVATE NATURE. PLEASE BE ASSURED OF CONFIDENTIALITY. INFORMATION WILL BE SHARED ON AN AS-NEEDED BASIS, AND ONLY WITH THOSE WHO STAFF OR LEADERS WHO DIRECTLY INTERACT WITH YOUR TEEN.

My teen has a food allergy*
Yes
No
If you answered yes to a food allergy, please list/describe the allergy, the severity, and be specific as to what they cannot have (i.e.: Milk allergy: can eat food with milk in it but cannot drink a glass of milk)
My teen has a non-food allergy*
Yes
No
If yes, please list the allergy/allergies and anything we should know (severity/best way to handle it for your teen; if they carry an epipen)
My teen has a medical/health condition (physical and mental health)*
Yes
No
If your teen has a physical or mental health condition, please list what we need to be aware of to take care of your teen, keep them safe, and assist them in forming healthy relationships with God, the Church, the leaders, and their peers
Please list any information on learning needs that your teen may have, as well as any accommodations/adaptations they may require in school. While we are not trained in special education, any information you provide us will better help us in forming your teen, and build a caring relationship with them.
Does your child have any learning needs and/or need any accommodations?*
Yes
No

PRIMARY CONTACT

First point of contact for all communications & primary emergency contact. For most teens, the primary contact is their parent/guardian

First Name *
Last Name *
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

SECONDARY CONTACT
Second point of contact for all communications & secondary emergency contact. For most teens, the secondary contact is their parent/guardian

First Name *
Last Name
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

EMERGENCY CONTACT

First/Last Name of another person we can call in the case of an emergency *
Phone Number (where they are easily reached) *
Relationship to the Teen

FAMILY INFORMATION & MAKE UP

Family dynamics always impact a teen, their image of God, and their faith journey. The information you provide helps us journey with your teen, and understand them better. Please let us know if the parents are divorced, separated, remarried, or dating; how your teen is handling that dynamic, where their primary residence is, are there step siblings, if there are multiple generations living in the house; have there been any recent deaths of close family or friends, or family pets, or any other information in this category that you think would be helpful for us.
List and briefly explain any concerns/situations that we should be aware of pertaining to the safety and security of your teen?
For your teen's safety, is there anyone who is NOT permitted to be with them? (if you have a supporting legal document, please provide a copy to the Director of Discipleship & Evangelization.
First Parent/Guardian Signature*
Second Teen's Name
First Name*
Last Name*
Teen's Date of Birth*
Date of Birth
Information
Teen's Cell Phone # for Flocknote (if they do not have their OWN cell, please enter NONE; do not re-enter a parent's number) *
Teen's Email for Flocknote (if they do not have their OWN email, please enter NONE; do not re-enter a parent's email) *
School District Attending*
Grade for 2026-2027*
My parish of registration is*
My teen has been baptized*
Yes, in the Catholic Church
Yes, in a non-Catholic Church (has not been brought into the Catholic Faith)
No
No, but is interested in being baptized
My teen has received the Sacrament of the Eucharist (1st Communion)*
Yes
No
No, but is interested in receiving the Sacrament
My teen has received the Sacrament of Confirmation (Chrismation for the Eastern Rite)*
Yes
No, Is younger than the normative age (6th & 7th graders)
No
No, but is interested in receiving the Sacrament

ANSWERS TO THE FOLLOWING QUESTIONS ARE OF A SENSITIVE AND PRIVATE NATURE. PLEASE BE ASSURED OF CONFIDENTIALITY. INFORMATION WILL BE SHARED ON AN AS-NEEDED BASIS, AND ONLY WITH THOSE WHO STAFF OR LEADERS WHO DIRECTLY INTERACT WITH YOUR TEEN.

My teen has a food allergy*
Yes
No
If you answered yes to a food allergy, please list/describe the allergy, the severity, and be specific as to what they cannot have (i.e.: Milk allergy: can eat food with milk in it but cannot drink a glass of milk)
My teen has a non-food allergy*
Yes
No
If yes, please list the allergy/allergies and anything we should know (severity/best way to handle it for your teen; if they carry an epipen)
My teen has a medical/health condition (physical and mental health)*
Yes
No
If your teen has a physical or mental health condition, please list what we need to be aware of to take care of your teen, keep them safe, and assist them in forming healthy relationships with God, the Church, the leaders, and their peers
Please list any information on learning needs that your teen may have, as well as any accommodations/adaptations they may require in school. While we are not trained in special education, any information you provide us will better help us in forming your teen, and build a caring relationship with them.
Does your child have any learning needs and/or need any accommodations?*
Yes
No

PRIMARY CONTACT

First point of contact for all communications & primary emergency contact. For most teens, the primary contact is their parent/guardian

First Name *
Last Name *
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

SECONDARY CONTACT
Second point of contact for all communications & secondary emergency contact. For most teens, the secondary contact is their parent/guardian

First Name *
Last Name
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

EMERGENCY CONTACT

First/Last Name of another person we can call in the case of an emergency *
Phone Number (where they are easily reached) *
Relationship to the Teen

FAMILY INFORMATION & MAKE UP

Family dynamics always impact a teen, their image of God, and their faith journey. The information you provide helps us journey with your teen, and understand them better. Please let us know if the parents are divorced, separated, remarried, or dating; how your teen is handling that dynamic, where their primary residence is, are there step siblings, if there are multiple generations living in the house; have there been any recent deaths of close family or friends, or family pets, or any other information in this category that you think would be helpful for us.
List and briefly explain any concerns/situations that we should be aware of pertaining to the safety and security of your teen?
For your teen's safety, is there anyone who is NOT permitted to be with them? (if you have a supporting legal document, please provide a copy to the Director of Discipleship & Evangelization.
Third Teen's Name
First Name*
Last Name*
Teen's Date of Birth*
Date of Birth
Information
Teen's Cell Phone # for Flocknote (if they do not have their OWN cell, please enter NONE; do not re-enter a parent's number) *
Teen's Email for Flocknote (if they do not have their OWN email, please enter NONE; do not re-enter a parent's email) *
School District Attending*
Grade for 2026-2027*
My parish of registration is*
My teen has been baptized*
Yes, in the Catholic Church
Yes, in a non-Catholic Church (has not been brought into the Catholic Faith)
No
No, but is interested in being baptized
My teen has received the Sacrament of the Eucharist (1st Communion)*
Yes
No
No, but is interested in receiving the Sacrament
My teen has received the Sacrament of Confirmation (Chrismation for the Eastern Rite)*
Yes
No, Is younger than the normative age (6th & 7th graders)
No
No, but is interested in receiving the Sacrament

ANSWERS TO THE FOLLOWING QUESTIONS ARE OF A SENSITIVE AND PRIVATE NATURE. PLEASE BE ASSURED OF CONFIDENTIALITY. INFORMATION WILL BE SHARED ON AN AS-NEEDED BASIS, AND ONLY WITH THOSE WHO STAFF OR LEADERS WHO DIRECTLY INTERACT WITH YOUR TEEN.

My teen has a food allergy*
Yes
No
If you answered yes to a food allergy, please list/describe the allergy, the severity, and be specific as to what they cannot have (i.e.: Milk allergy: can eat food with milk in it but cannot drink a glass of milk)
My teen has a non-food allergy*
Yes
No
If yes, please list the allergy/allergies and anything we should know (severity/best way to handle it for your teen; if they carry an epipen)
My teen has a medical/health condition (physical and mental health)*
Yes
No
If your teen has a physical or mental health condition, please list what we need to be aware of to take care of your teen, keep them safe, and assist them in forming healthy relationships with God, the Church, the leaders, and their peers
Please list any information on learning needs that your teen may have, as well as any accommodations/adaptations they may require in school. While we are not trained in special education, any information you provide us will better help us in forming your teen, and build a caring relationship with them.
Does your child have any learning needs and/or need any accommodations?*
Yes
No

PRIMARY CONTACT

First point of contact for all communications & primary emergency contact. For most teens, the primary contact is their parent/guardian

First Name *
Last Name *
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

SECONDARY CONTACT
Second point of contact for all communications & secondary emergency contact. For most teens, the secondary contact is their parent/guardian

First Name *
Last Name
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

EMERGENCY CONTACT

First/Last Name of another person we can call in the case of an emergency *
Phone Number (where they are easily reached) *
Relationship to the Teen

FAMILY INFORMATION & MAKE UP

Family dynamics always impact a teen, their image of God, and their faith journey. The information you provide helps us journey with your teen, and understand them better. Please let us know if the parents are divorced, separated, remarried, or dating; how your teen is handling that dynamic, where their primary residence is, are there step siblings, if there are multiple generations living in the house; have there been any recent deaths of close family or friends, or family pets, or any other information in this category that you think would be helpful for us.
List and briefly explain any concerns/situations that we should be aware of pertaining to the safety and security of your teen?
For your teen's safety, is there anyone who is NOT permitted to be with them? (if you have a supporting legal document, please provide a copy to the Director of Discipleship & Evangelization.
Fourth Teen's Name
First Name*
Last Name*
Teen's Date of Birth*
Date of Birth
Information
Teen's Cell Phone # for Flocknote (if they do not have their OWN cell, please enter NONE; do not re-enter a parent's number) *
Teen's Email for Flocknote (if they do not have their OWN email, please enter NONE; do not re-enter a parent's email) *
School District Attending*
Grade for 2026-2027*
My parish of registration is*
My teen has been baptized*
Yes, in the Catholic Church
Yes, in a non-Catholic Church (has not been brought into the Catholic Faith)
No
No, but is interested in being baptized
My teen has received the Sacrament of the Eucharist (1st Communion)*
Yes
No
No, but is interested in receiving the Sacrament
My teen has received the Sacrament of Confirmation (Chrismation for the Eastern Rite)*
Yes
No, Is younger than the normative age (6th & 7th graders)
No
No, but is interested in receiving the Sacrament

ANSWERS TO THE FOLLOWING QUESTIONS ARE OF A SENSITIVE AND PRIVATE NATURE. PLEASE BE ASSURED OF CONFIDENTIALITY. INFORMATION WILL BE SHARED ON AN AS-NEEDED BASIS, AND ONLY WITH THOSE WHO STAFF OR LEADERS WHO DIRECTLY INTERACT WITH YOUR TEEN.

My teen has a food allergy*
Yes
No
If you answered yes to a food allergy, please list/describe the allergy, the severity, and be specific as to what they cannot have (i.e.: Milk allergy: can eat food with milk in it but cannot drink a glass of milk)
My teen has a non-food allergy*
Yes
No
If yes, please list the allergy/allergies and anything we should know (severity/best way to handle it for your teen; if they carry an epipen)
My teen has a medical/health condition (physical and mental health)*
Yes
No
If your teen has a physical or mental health condition, please list what we need to be aware of to take care of your teen, keep them safe, and assist them in forming healthy relationships with God, the Church, the leaders, and their peers
Please list any information on learning needs that your teen may have, as well as any accommodations/adaptations they may require in school. While we are not trained in special education, any information you provide us will better help us in forming your teen, and build a caring relationship with them.
Does your child have any learning needs and/or need any accommodations?*
Yes
No

PRIMARY CONTACT

First point of contact for all communications & primary emergency contact. For most teens, the primary contact is their parent/guardian

First Name *
Last Name *
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

SECONDARY CONTACT
Second point of contact for all communications & secondary emergency contact. For most teens, the secondary contact is their parent/guardian

First Name *
Last Name
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

EMERGENCY CONTACT

First/Last Name of another person we can call in the case of an emergency *
Phone Number (where they are easily reached) *
Relationship to the Teen

FAMILY INFORMATION & MAKE UP

Family dynamics always impact a teen, their image of God, and their faith journey. The information you provide helps us journey with your teen, and understand them better. Please let us know if the parents are divorced, separated, remarried, or dating; how your teen is handling that dynamic, where their primary residence is, are there step siblings, if there are multiple generations living in the house; have there been any recent deaths of close family or friends, or family pets, or any other information in this category that you think would be helpful for us.
List and briefly explain any concerns/situations that we should be aware of pertaining to the safety and security of your teen?
For your teen's safety, is there anyone who is NOT permitted to be with them? (if you have a supporting legal document, please provide a copy to the Director of Discipleship & Evangelization.
Fifth Teen's Name
First Name*
Last Name*
Teen's Date of Birth*
Date of Birth
Information
Teen's Cell Phone # for Flocknote (if they do not have their OWN cell, please enter NONE; do not re-enter a parent's number) *
Teen's Email for Flocknote (if they do not have their OWN email, please enter NONE; do not re-enter a parent's email) *
School District Attending*
Grade for 2026-2027*
My parish of registration is*
My teen has been baptized*
Yes, in the Catholic Church
Yes, in a non-Catholic Church (has not been brought into the Catholic Faith)
No
No, but is interested in being baptized
My teen has received the Sacrament of the Eucharist (1st Communion)*
Yes
No
No, but is interested in receiving the Sacrament
My teen has received the Sacrament of Confirmation (Chrismation for the Eastern Rite)*
Yes
No, Is younger than the normative age (6th & 7th graders)
No
No, but is interested in receiving the Sacrament

ANSWERS TO THE FOLLOWING QUESTIONS ARE OF A SENSITIVE AND PRIVATE NATURE. PLEASE BE ASSURED OF CONFIDENTIALITY. INFORMATION WILL BE SHARED ON AN AS-NEEDED BASIS, AND ONLY WITH THOSE WHO STAFF OR LEADERS WHO DIRECTLY INTERACT WITH YOUR TEEN.

My teen has a food allergy*
Yes
No
If you answered yes to a food allergy, please list/describe the allergy, the severity, and be specific as to what they cannot have (i.e.: Milk allergy: can eat food with milk in it but cannot drink a glass of milk)
My teen has a non-food allergy*
Yes
No
If yes, please list the allergy/allergies and anything we should know (severity/best way to handle it for your teen; if they carry an epipen)
My teen has a medical/health condition (physical and mental health)*
Yes
No
If your teen has a physical or mental health condition, please list what we need to be aware of to take care of your teen, keep them safe, and assist them in forming healthy relationships with God, the Church, the leaders, and their peers
Please list any information on learning needs that your teen may have, as well as any accommodations/adaptations they may require in school. While we are not trained in special education, any information you provide us will better help us in forming your teen, and build a caring relationship with them.
Does your child have any learning needs and/or need any accommodations?*
Yes
No

PRIMARY CONTACT

First point of contact for all communications & primary emergency contact. For most teens, the primary contact is their parent/guardian

First Name *
Last Name *
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

SECONDARY CONTACT
Second point of contact for all communications & secondary emergency contact. For most teens, the secondary contact is their parent/guardian

First Name *
Last Name
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

EMERGENCY CONTACT

First/Last Name of another person we can call in the case of an emergency *
Phone Number (where they are easily reached) *
Relationship to the Teen

FAMILY INFORMATION & MAKE UP

Family dynamics always impact a teen, their image of God, and their faith journey. The information you provide helps us journey with your teen, and understand them better. Please let us know if the parents are divorced, separated, remarried, or dating; how your teen is handling that dynamic, where their primary residence is, are there step siblings, if there are multiple generations living in the house; have there been any recent deaths of close family or friends, or family pets, or any other information in this category that you think would be helpful for us.
List and briefly explain any concerns/situations that we should be aware of pertaining to the safety and security of your teen?
For your teen's safety, is there anyone who is NOT permitted to be with them? (if you have a supporting legal document, please provide a copy to the Director of Discipleship & Evangelization.
Sixth Teen's Name
First Name*
Last Name*
Teen's Date of Birth*
Date of Birth
Information
Teen's Cell Phone # for Flocknote (if they do not have their OWN cell, please enter NONE; do not re-enter a parent's number) *
Teen's Email for Flocknote (if they do not have their OWN email, please enter NONE; do not re-enter a parent's email) *
School District Attending*
Grade for 2026-2027*
My parish of registration is*
My teen has been baptized*
Yes, in the Catholic Church
Yes, in a non-Catholic Church (has not been brought into the Catholic Faith)
No
No, but is interested in being baptized
My teen has received the Sacrament of the Eucharist (1st Communion)*
Yes
No
No, but is interested in receiving the Sacrament
My teen has received the Sacrament of Confirmation (Chrismation for the Eastern Rite)*
Yes
No, Is younger than the normative age (6th & 7th graders)
No
No, but is interested in receiving the Sacrament

ANSWERS TO THE FOLLOWING QUESTIONS ARE OF A SENSITIVE AND PRIVATE NATURE. PLEASE BE ASSURED OF CONFIDENTIALITY. INFORMATION WILL BE SHARED ON AN AS-NEEDED BASIS, AND ONLY WITH THOSE WHO STAFF OR LEADERS WHO DIRECTLY INTERACT WITH YOUR TEEN.

My teen has a food allergy*
Yes
No
If you answered yes to a food allergy, please list/describe the allergy, the severity, and be specific as to what they cannot have (i.e.: Milk allergy: can eat food with milk in it but cannot drink a glass of milk)
My teen has a non-food allergy*
Yes
No
If yes, please list the allergy/allergies and anything we should know (severity/best way to handle it for your teen; if they carry an epipen)
My teen has a medical/health condition (physical and mental health)*
Yes
No
If your teen has a physical or mental health condition, please list what we need to be aware of to take care of your teen, keep them safe, and assist them in forming healthy relationships with God, the Church, the leaders, and their peers
Please list any information on learning needs that your teen may have, as well as any accommodations/adaptations they may require in school. While we are not trained in special education, any information you provide us will better help us in forming your teen, and build a caring relationship with them.
Does your child have any learning needs and/or need any accommodations?*
Yes
No

PRIMARY CONTACT

First point of contact for all communications & primary emergency contact. For most teens, the primary contact is their parent/guardian

First Name *
Last Name *
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

SECONDARY CONTACT
Second point of contact for all communications & secondary emergency contact. For most teens, the secondary contact is their parent/guardian

First Name *
Last Name
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

EMERGENCY CONTACT

First/Last Name of another person we can call in the case of an emergency *
Phone Number (where they are easily reached) *
Relationship to the Teen

FAMILY INFORMATION & MAKE UP

Family dynamics always impact a teen, their image of God, and their faith journey. The information you provide helps us journey with your teen, and understand them better. Please let us know if the parents are divorced, separated, remarried, or dating; how your teen is handling that dynamic, where their primary residence is, are there step siblings, if there are multiple generations living in the house; have there been any recent deaths of close family or friends, or family pets, or any other information in this category that you think would be helpful for us.
List and briefly explain any concerns/situations that we should be aware of pertaining to the safety and security of your teen?
For your teen's safety, is there anyone who is NOT permitted to be with them? (if you have a supporting legal document, please provide a copy to the Director of Discipleship & Evangelization.
Seventh Teen's Name
First Name*
Last Name*
Teen's Date of Birth*
Date of Birth
Information
Teen's Cell Phone # for Flocknote (if they do not have their OWN cell, please enter NONE; do not re-enter a parent's number) *
Teen's Email for Flocknote (if they do not have their OWN email, please enter NONE; do not re-enter a parent's email) *
School District Attending*
Grade for 2026-2027*
My parish of registration is*
My teen has been baptized*
Yes, in the Catholic Church
Yes, in a non-Catholic Church (has not been brought into the Catholic Faith)
No
No, but is interested in being baptized
My teen has received the Sacrament of the Eucharist (1st Communion)*
Yes
No
No, but is interested in receiving the Sacrament
My teen has received the Sacrament of Confirmation (Chrismation for the Eastern Rite)*
Yes
No, Is younger than the normative age (6th & 7th graders)
No
No, but is interested in receiving the Sacrament

ANSWERS TO THE FOLLOWING QUESTIONS ARE OF A SENSITIVE AND PRIVATE NATURE. PLEASE BE ASSURED OF CONFIDENTIALITY. INFORMATION WILL BE SHARED ON AN AS-NEEDED BASIS, AND ONLY WITH THOSE WHO STAFF OR LEADERS WHO DIRECTLY INTERACT WITH YOUR TEEN.

My teen has a food allergy*
Yes
No
If you answered yes to a food allergy, please list/describe the allergy, the severity, and be specific as to what they cannot have (i.e.: Milk allergy: can eat food with milk in it but cannot drink a glass of milk)
My teen has a non-food allergy*
Yes
No
If yes, please list the allergy/allergies and anything we should know (severity/best way to handle it for your teen; if they carry an epipen)
My teen has a medical/health condition (physical and mental health)*
Yes
No
If your teen has a physical or mental health condition, please list what we need to be aware of to take care of your teen, keep them safe, and assist them in forming healthy relationships with God, the Church, the leaders, and their peers
Please list any information on learning needs that your teen may have, as well as any accommodations/adaptations they may require in school. While we are not trained in special education, any information you provide us will better help us in forming your teen, and build a caring relationship with them.
Does your child have any learning needs and/or need any accommodations?*
Yes
No

PRIMARY CONTACT

First point of contact for all communications & primary emergency contact. For most teens, the primary contact is their parent/guardian

First Name *
Last Name *
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

SECONDARY CONTACT
Second point of contact for all communications & secondary emergency contact. For most teens, the secondary contact is their parent/guardian

First Name *
Last Name
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

EMERGENCY CONTACT

First/Last Name of another person we can call in the case of an emergency *
Phone Number (where they are easily reached) *
Relationship to the Teen

FAMILY INFORMATION & MAKE UP

Family dynamics always impact a teen, their image of God, and their faith journey. The information you provide helps us journey with your teen, and understand them better. Please let us know if the parents are divorced, separated, remarried, or dating; how your teen is handling that dynamic, where their primary residence is, are there step siblings, if there are multiple generations living in the house; have there been any recent deaths of close family or friends, or family pets, or any other information in this category that you think would be helpful for us.
List and briefly explain any concerns/situations that we should be aware of pertaining to the safety and security of your teen?
For your teen's safety, is there anyone who is NOT permitted to be with them? (if you have a supporting legal document, please provide a copy to the Director of Discipleship & Evangelization.
Eighth Teen's Name
First Name*
Last Name*
Teen's Date of Birth*
Date of Birth
Information
Teen's Cell Phone # for Flocknote (if they do not have their OWN cell, please enter NONE; do not re-enter a parent's number) *
Teen's Email for Flocknote (if they do not have their OWN email, please enter NONE; do not re-enter a parent's email) *
School District Attending*
Grade for 2026-2027*
My parish of registration is*
My teen has been baptized*
Yes, in the Catholic Church
Yes, in a non-Catholic Church (has not been brought into the Catholic Faith)
No
No, but is interested in being baptized
My teen has received the Sacrament of the Eucharist (1st Communion)*
Yes
No
No, but is interested in receiving the Sacrament
My teen has received the Sacrament of Confirmation (Chrismation for the Eastern Rite)*
Yes
No, Is younger than the normative age (6th & 7th graders)
No
No, but is interested in receiving the Sacrament

ANSWERS TO THE FOLLOWING QUESTIONS ARE OF A SENSITIVE AND PRIVATE NATURE. PLEASE BE ASSURED OF CONFIDENTIALITY. INFORMATION WILL BE SHARED ON AN AS-NEEDED BASIS, AND ONLY WITH THOSE WHO STAFF OR LEADERS WHO DIRECTLY INTERACT WITH YOUR TEEN.

My teen has a food allergy*
Yes
No
If you answered yes to a food allergy, please list/describe the allergy, the severity, and be specific as to what they cannot have (i.e.: Milk allergy: can eat food with milk in it but cannot drink a glass of milk)
My teen has a non-food allergy*
Yes
No
If yes, please list the allergy/allergies and anything we should know (severity/best way to handle it for your teen; if they carry an epipen)
My teen has a medical/health condition (physical and mental health)*
Yes
No
If your teen has a physical or mental health condition, please list what we need to be aware of to take care of your teen, keep them safe, and assist them in forming healthy relationships with God, the Church, the leaders, and their peers
Please list any information on learning needs that your teen may have, as well as any accommodations/adaptations they may require in school. While we are not trained in special education, any information you provide us will better help us in forming your teen, and build a caring relationship with them.
Does your child have any learning needs and/or need any accommodations?*
Yes
No

PRIMARY CONTACT

First point of contact for all communications & primary emergency contact. For most teens, the primary contact is their parent/guardian

First Name *
Last Name *
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

SECONDARY CONTACT
Second point of contact for all communications & secondary emergency contact. For most teens, the secondary contact is their parent/guardian

First Name *
Last Name
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

EMERGENCY CONTACT

First/Last Name of another person we can call in the case of an emergency *
Phone Number (where they are easily reached) *
Relationship to the Teen

FAMILY INFORMATION & MAKE UP

Family dynamics always impact a teen, their image of God, and their faith journey. The information you provide helps us journey with your teen, and understand them better. Please let us know if the parents are divorced, separated, remarried, or dating; how your teen is handling that dynamic, where their primary residence is, are there step siblings, if there are multiple generations living in the house; have there been any recent deaths of close family or friends, or family pets, or any other information in this category that you think would be helpful for us.
List and briefly explain any concerns/situations that we should be aware of pertaining to the safety and security of your teen?
For your teen's safety, is there anyone who is NOT permitted to be with them? (if you have a supporting legal document, please provide a copy to the Director of Discipleship & Evangelization.
Ninth Teen's Name
First Name*
Last Name*
Teen's Date of Birth*
Date of Birth
Information
Teen's Cell Phone # for Flocknote (if they do not have their OWN cell, please enter NONE; do not re-enter a parent's number) *
Teen's Email for Flocknote (if they do not have their OWN email, please enter NONE; do not re-enter a parent's email) *
School District Attending*
Grade for 2026-2027*
My parish of registration is*
My teen has been baptized*
Yes, in the Catholic Church
Yes, in a non-Catholic Church (has not been brought into the Catholic Faith)
No
No, but is interested in being baptized
My teen has received the Sacrament of the Eucharist (1st Communion)*
Yes
No
No, but is interested in receiving the Sacrament
My teen has received the Sacrament of Confirmation (Chrismation for the Eastern Rite)*
Yes
No, Is younger than the normative age (6th & 7th graders)
No
No, but is interested in receiving the Sacrament

ANSWERS TO THE FOLLOWING QUESTIONS ARE OF A SENSITIVE AND PRIVATE NATURE. PLEASE BE ASSURED OF CONFIDENTIALITY. INFORMATION WILL BE SHARED ON AN AS-NEEDED BASIS, AND ONLY WITH THOSE WHO STAFF OR LEADERS WHO DIRECTLY INTERACT WITH YOUR TEEN.

My teen has a food allergy*
Yes
No
If you answered yes to a food allergy, please list/describe the allergy, the severity, and be specific as to what they cannot have (i.e.: Milk allergy: can eat food with milk in it but cannot drink a glass of milk)
My teen has a non-food allergy*
Yes
No
If yes, please list the allergy/allergies and anything we should know (severity/best way to handle it for your teen; if they carry an epipen)
My teen has a medical/health condition (physical and mental health)*
Yes
No
If your teen has a physical or mental health condition, please list what we need to be aware of to take care of your teen, keep them safe, and assist them in forming healthy relationships with God, the Church, the leaders, and their peers
Please list any information on learning needs that your teen may have, as well as any accommodations/adaptations they may require in school. While we are not trained in special education, any information you provide us will better help us in forming your teen, and build a caring relationship with them.
Does your child have any learning needs and/or need any accommodations?*
Yes
No

PRIMARY CONTACT

First point of contact for all communications & primary emergency contact. For most teens, the primary contact is their parent/guardian

First Name *
Last Name *
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

SECONDARY CONTACT
Second point of contact for all communications & secondary emergency contact. For most teens, the secondary contact is their parent/guardian

First Name *
Last Name
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

EMERGENCY CONTACT

First/Last Name of another person we can call in the case of an emergency *
Phone Number (where they are easily reached) *
Relationship to the Teen

FAMILY INFORMATION & MAKE UP

Family dynamics always impact a teen, their image of God, and their faith journey. The information you provide helps us journey with your teen, and understand them better. Please let us know if the parents are divorced, separated, remarried, or dating; how your teen is handling that dynamic, where their primary residence is, are there step siblings, if there are multiple generations living in the house; have there been any recent deaths of close family or friends, or family pets, or any other information in this category that you think would be helpful for us.
List and briefly explain any concerns/situations that we should be aware of pertaining to the safety and security of your teen?
For your teen's safety, is there anyone who is NOT permitted to be with them? (if you have a supporting legal document, please provide a copy to the Director of Discipleship & Evangelization.
Tenth Teen's Name
First Name*
Last Name*
Teen's Date of Birth*
Date of Birth
Information
Teen's Cell Phone # for Flocknote (if they do not have their OWN cell, please enter NONE; do not re-enter a parent's number) *
Teen's Email for Flocknote (if they do not have their OWN email, please enter NONE; do not re-enter a parent's email) *
School District Attending*
Grade for 2026-2027*
My parish of registration is*
My teen has been baptized*
Yes, in the Catholic Church
Yes, in a non-Catholic Church (has not been brought into the Catholic Faith)
No
No, but is interested in being baptized
My teen has received the Sacrament of the Eucharist (1st Communion)*
Yes
No
No, but is interested in receiving the Sacrament
My teen has received the Sacrament of Confirmation (Chrismation for the Eastern Rite)*
Yes
No, Is younger than the normative age (6th & 7th graders)
No
No, but is interested in receiving the Sacrament

ANSWERS TO THE FOLLOWING QUESTIONS ARE OF A SENSITIVE AND PRIVATE NATURE. PLEASE BE ASSURED OF CONFIDENTIALITY. INFORMATION WILL BE SHARED ON AN AS-NEEDED BASIS, AND ONLY WITH THOSE WHO STAFF OR LEADERS WHO DIRECTLY INTERACT WITH YOUR TEEN.

My teen has a food allergy*
Yes
No
If you answered yes to a food allergy, please list/describe the allergy, the severity, and be specific as to what they cannot have (i.e.: Milk allergy: can eat food with milk in it but cannot drink a glass of milk)
My teen has a non-food allergy*
Yes
No
If yes, please list the allergy/allergies and anything we should know (severity/best way to handle it for your teen; if they carry an epipen)
My teen has a medical/health condition (physical and mental health)*
Yes
No
If your teen has a physical or mental health condition, please list what we need to be aware of to take care of your teen, keep them safe, and assist them in forming healthy relationships with God, the Church, the leaders, and their peers
Please list any information on learning needs that your teen may have, as well as any accommodations/adaptations they may require in school. While we are not trained in special education, any information you provide us will better help us in forming your teen, and build a caring relationship with them.
Does your child have any learning needs and/or need any accommodations?*
Yes
No

PRIMARY CONTACT

First point of contact for all communications & primary emergency contact. For most teens, the primary contact is their parent/guardian

First Name *
Last Name *
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

SECONDARY CONTACT
Second point of contact for all communications & secondary emergency contact. For most teens, the secondary contact is their parent/guardian

First Name *
Last Name
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

EMERGENCY CONTACT

First/Last Name of another person we can call in the case of an emergency *
Phone Number (where they are easily reached) *
Relationship to the Teen

FAMILY INFORMATION & MAKE UP

Family dynamics always impact a teen, their image of God, and their faith journey. The information you provide helps us journey with your teen, and understand them better. Please let us know if the parents are divorced, separated, remarried, or dating; how your teen is handling that dynamic, where their primary residence is, are there step siblings, if there are multiple generations living in the house; have there been any recent deaths of close family or friends, or family pets, or any other information in this category that you think would be helpful for us.
List and briefly explain any concerns/situations that we should be aware of pertaining to the safety and security of your teen?
For your teen's safety, is there anyone who is NOT permitted to be with them? (if you have a supporting legal document, please provide a copy to the Director of Discipleship & Evangelization.
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.
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*
Last Name*
Relationship*
Parent or Guardian's Date of Birth*
Date of Birth
Information
Teen's Cell Phone # for Flocknote (if they do not have their OWN cell, please enter NONE; do not re-enter a parent's number) *
Teen's Email for Flocknote (if they do not have their OWN email, please enter NONE; do not re-enter a parent's email) *
School District Attending*
Grade for 2026-2027*
My parish of registration is*
My teen has been baptized*
Yes, in the Catholic Church
Yes, in a non-Catholic Church (has not been brought into the Catholic Faith)
No
No, but is interested in being baptized
My teen has received the Sacrament of the Eucharist (1st Communion)*
Yes
No
No, but is interested in receiving the Sacrament
My teen has received the Sacrament of Confirmation (Chrismation for the Eastern Rite)*
Yes
No, Is younger than the normative age (6th & 7th graders)
No
No, but is interested in receiving the Sacrament

ANSWERS TO THE FOLLOWING QUESTIONS ARE OF A SENSITIVE AND PRIVATE NATURE. PLEASE BE ASSURED OF CONFIDENTIALITY. INFORMATION WILL BE SHARED ON AN AS-NEEDED BASIS, AND ONLY WITH THOSE WHO STAFF OR LEADERS WHO DIRECTLY INTERACT WITH YOUR TEEN.

My teen has a food allergy*
Yes
No
If you answered yes to a food allergy, please list/describe the allergy, the severity, and be specific as to what they cannot have (i.e.: Milk allergy: can eat food with milk in it but cannot drink a glass of milk)
My teen has a non-food allergy*
Yes
No
If yes, please list the allergy/allergies and anything we should know (severity/best way to handle it for your teen; if they carry an epipen)
My teen has a medical/health condition (physical and mental health)*
Yes
No
If your teen has a physical or mental health condition, please list what we need to be aware of to take care of your teen, keep them safe, and assist them in forming healthy relationships with God, the Church, the leaders, and their peers
Please list any information on learning needs that your teen may have, as well as any accommodations/adaptations they may require in school. While we are not trained in special education, any information you provide us will better help us in forming your teen, and build a caring relationship with them.
Does your child have any learning needs and/or need any accommodations?*
Yes
No

PRIMARY CONTACT

First point of contact for all communications & primary emergency contact. For most teens, the primary contact is their parent/guardian

First Name *
Last Name *
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

SECONDARY CONTACT
Second point of contact for all communications & secondary emergency contact. For most teens, the secondary contact is their parent/guardian

First Name *
Last Name
Email *
Primary Phone *
This number is a*
Secondary Number (if you have one)
This number is a
Relationship to the Teen*

EMERGENCY CONTACT

First/Last Name of another person we can call in the case of an emergency *
Phone Number (where they are easily reached) *
Relationship to the Teen

FAMILY INFORMATION & MAKE UP

Family dynamics always impact a teen, their image of God, and their faith journey. The information you provide helps us journey with your teen, and understand them better. Please let us know if the parents are divorced, separated, remarried, or dating; how your teen is handling that dynamic, where their primary residence is, are there step siblings, if there are multiple generations living in the house; have there been any recent deaths of close family or friends, or family pets, or any other information in this category that you think would be helpful for us.
List and briefly explain any concerns/situations that we should be aware of pertaining to the safety and security of your teen?
For your teen's safety, is there anyone who is NOT permitted to be with them? (if you have a supporting legal document, please provide a copy to the Director of Discipleship & Evangelization.
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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