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Our Lady of Grace & St. Benedict

Youth Ministry


approximately 2 Sundays per month

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 

  

Registration is required for participation in Youth Ministry.

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

NAME OF THE MINISTRY: Youth Ministry

DATES OF THE MINISTRY: see schedule

NAME OF PARISH HOSTING THE MINISTRY: Our Lady of Grace Church

ADDRESS OF PARISH HOSTING THE MINISTRY:
      1011 Mount Pleasant Road, Greensburg, PA 15601

ON-SITE MINISTRY SUPERVISOR: 
     Emily Weaver, Assistant for Discipleship & Evangelization

CONTACT INFORMATION FOR ON-SITE MINISTRY SUPERVISOR: 
     724-838-9480 x 33  or  eweaver@dioceseofgreensburg.org

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 child(ren) in the ministry described above. I understand that this ministry 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 treated 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 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 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, 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 

We, the parents/guardians do hereby give our permission for him/her to attend VIRTUAL YOUTH MINISTRY SESSIONS for the 2025-2026 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 students and catechists to access and share information on a global scale. The scholarly use of the Internet can provide our students and catechists with a world-wide, 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 catechist and others in the virtual classroom.
  • Teens' screen 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. Student 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 parishes 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 web site 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 child 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.


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..

Date: August 25, 2025

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.

I AGREE to the Photo Release
I DO NOT Agree to the Photo Release
First Teen's Name
First Name*
Last Name*
Select Gender
First Teen's Date of Birth*
Date of Birth
First Teen's Information
Teen's Cell Phone # (if they do not have their own cell phone, enter none) *
Teen's Email (if teens does not have their own email, type none) *
School Attending *
Grade Level for Fall 2025-2026*
My parish of registration is:*
Our Lady of Grace
Saint Benedict
Other
If other, what is your parish of registration?
Sacraments my teen HAS ALREADY received (check all that apply) *
Baptism
First Holy Communion
Confirmation
None
My teen has a food allergy*
No
Yes
If answered yes to food allergy, please list/describe the allergy and be specific. (i.e.: Milk allergy: can eat food with milk in it; cannot drink glass of milk)
My teen has a non-food allergy:*
No
Yes
If yes, please list the allergy/allergies:
My teen has a learning disability*
No
Yes
If answered yes to learning disability, please list ALL learning disabilities. This information is to assist us in forming your teen by adapting the material. Your privacy will be respected.
My teen has a medical condition*
No
Yes
If answered yes to medical condition, please list ALL medical conditions
Please list any special accommodations that your teen may need
First Teen's Signature*
Second Teen's Name
First Name*
Last Name*
Select Gender
Teen's Date of Birth*
Date of Birth
Second Teen's Information
Teen's Cell Phone # (if they do not have their own cell phone, enter none) *
Teen's Email (if teens does not have their own email, type none) *
School Attending *
Grade Level for Fall 2025-2026*
My parish of registration is:*
Our Lady of Grace
Saint Benedict
Other
If other, what is your parish of registration?
Sacraments my teen HAS ALREADY received (check all that apply) *
Baptism
First Holy Communion
Confirmation
None
My teen has a food allergy*
No
Yes
If answered yes to food allergy, please list/describe the allergy and be specific. (i.e.: Milk allergy: can eat food with milk in it; cannot drink glass of milk)
My teen has a non-food allergy:*
No
Yes
If yes, please list the allergy/allergies:
My teen has a learning disability*
No
Yes
If answered yes to learning disability, please list ALL learning disabilities. This information is to assist us in forming your teen by adapting the material. Your privacy will be respected.
My teen has a medical condition*
No
Yes
If answered yes to medical condition, please list ALL medical conditions
Please list any special accommodations that your teen may need
Third Teen's Name
First Name*
Last Name*
Select Gender
Teen's Date of Birth*
Date of Birth
Third Teen's Information
Teen's Cell Phone # (if they do not have their own cell phone, enter none) *
Teen's Email (if teens does not have their own email, type none) *
School Attending *
Grade Level for Fall 2025-2026*
My parish of registration is:*
Our Lady of Grace
Saint Benedict
Other
If other, what is your parish of registration?
Sacraments my teen HAS ALREADY received (check all that apply) *
Baptism
First Holy Communion
Confirmation
None
My teen has a food allergy*
No
Yes
If answered yes to food allergy, please list/describe the allergy and be specific. (i.e.: Milk allergy: can eat food with milk in it; cannot drink glass of milk)
My teen has a non-food allergy:*
No
Yes
If yes, please list the allergy/allergies:
My teen has a learning disability*
No
Yes
If answered yes to learning disability, please list ALL learning disabilities. This information is to assist us in forming your teen by adapting the material. Your privacy will be respected.
My teen has a medical condition*
No
Yes
If answered yes to medical condition, please list ALL medical conditions
Please list any special accommodations that your teen may need
Fourth Teen's Name
First Name*
Last Name*
Select Gender
Teen's Date of Birth*
Date of Birth
Fourth Teen's Information
Teen's Cell Phone # (if they do not have their own cell phone, enter none) *
Teen's Email (if teens does not have their own email, type none) *
School Attending *
Grade Level for Fall 2025-2026*
My parish of registration is:*
Our Lady of Grace
Saint Benedict
Other
If other, what is your parish of registration?
Sacraments my teen HAS ALREADY received (check all that apply) *
Baptism
First Holy Communion
Confirmation
None
My teen has a food allergy*
No
Yes
If answered yes to food allergy, please list/describe the allergy and be specific. (i.e.: Milk allergy: can eat food with milk in it; cannot drink glass of milk)
My teen has a non-food allergy:*
No
Yes
If yes, please list the allergy/allergies:
My teen has a learning disability*
No
Yes
If answered yes to learning disability, please list ALL learning disabilities. This information is to assist us in forming your teen by adapting the material. Your privacy will be respected.
My teen has a medical condition*
No
Yes
If answered yes to medical condition, please list ALL medical conditions
Please list any special accommodations that your teen may need
Fifth Teen's Name
First Name*
Last Name*
Select Gender
Teen's Date of Birth*
Date of Birth
Fifth Teen's Information
Teen's Cell Phone # (if they do not have their own cell phone, enter none) *
Teen's Email (if teens does not have their own email, type none) *
School Attending *
Grade Level for Fall 2025-2026*
My parish of registration is:*
Our Lady of Grace
Saint Benedict
Other
If other, what is your parish of registration?
Sacraments my teen HAS ALREADY received (check all that apply) *
Baptism
First Holy Communion
Confirmation
None
My teen has a food allergy*
No
Yes
If answered yes to food allergy, please list/describe the allergy and be specific. (i.e.: Milk allergy: can eat food with milk in it; cannot drink glass of milk)
My teen has a non-food allergy:*
No
Yes
If yes, please list the allergy/allergies:
My teen has a learning disability*
No
Yes
If answered yes to learning disability, please list ALL learning disabilities. This information is to assist us in forming your teen by adapting the material. Your privacy will be respected.
My teen has a medical condition*
No
Yes
If answered yes to medical condition, please list ALL medical conditions
Please list any special accommodations that your teen may need
Sixth Teen's Name
First Name*
Last Name*
Select Gender
Teen's Date of Birth*
Date of Birth
Sixth Teen's Information
Teen's Cell Phone # (if they do not have their own cell phone, enter none) *
Teen's Email (if teens does not have their own email, type none) *
School Attending *
Grade Level for Fall 2025-2026*
My parish of registration is:*
Our Lady of Grace
Saint Benedict
Other
If other, what is your parish of registration?
Sacraments my teen HAS ALREADY received (check all that apply) *
Baptism
First Holy Communion
Confirmation
None
My teen has a food allergy*
No
Yes
If answered yes to food allergy, please list/describe the allergy and be specific. (i.e.: Milk allergy: can eat food with milk in it; cannot drink glass of milk)
My teen has a non-food allergy:*
No
Yes
If yes, please list the allergy/allergies:
My teen has a learning disability*
No
Yes
If answered yes to learning disability, please list ALL learning disabilities. This information is to assist us in forming your teen by adapting the material. Your privacy will be respected.
My teen has a medical condition*
No
Yes
If answered yes to medical condition, please list ALL medical conditions
Please list any special accommodations that your teen may need
Seventh Teen's Name
First Name*
Last Name*
Select Gender
Teen's Date of Birth*
Date of Birth
Seventh Teen's Information
Teen's Cell Phone # (if they do not have their own cell phone, enter none) *
Teen's Email (if teens does not have their own email, type none) *
School Attending *
Grade Level for Fall 2025-2026*
My parish of registration is:*
Our Lady of Grace
Saint Benedict
Other
If other, what is your parish of registration?
Sacraments my teen HAS ALREADY received (check all that apply) *
Baptism
First Holy Communion
Confirmation
None
My teen has a food allergy*
No
Yes
If answered yes to food allergy, please list/describe the allergy and be specific. (i.e.: Milk allergy: can eat food with milk in it; cannot drink glass of milk)
My teen has a non-food allergy:*
No
Yes
If yes, please list the allergy/allergies:
My teen has a learning disability*
No
Yes
If answered yes to learning disability, please list ALL learning disabilities. This information is to assist us in forming your teen by adapting the material. Your privacy will be respected.
My teen has a medical condition*
No
Yes
If answered yes to medical condition, please list ALL medical conditions
Please list any special accommodations that your teen may need
Eighth Teen's Name
First Name*
Last Name*
Select Gender
Teen's Date of Birth*
Date of Birth
Eighth Teen's Information
Teen's Cell Phone # (if they do not have their own cell phone, enter none) *
Teen's Email (if teens does not have their own email, type none) *
School Attending *
Grade Level for Fall 2025-2026*
My parish of registration is:*
Our Lady of Grace
Saint Benedict
Other
If other, what is your parish of registration?
Sacraments my teen HAS ALREADY received (check all that apply) *
Baptism
First Holy Communion
Confirmation
None
My teen has a food allergy*
No
Yes
If answered yes to food allergy, please list/describe the allergy and be specific. (i.e.: Milk allergy: can eat food with milk in it; cannot drink glass of milk)
My teen has a non-food allergy:*
No
Yes
If yes, please list the allergy/allergies:
My teen has a learning disability*
No
Yes
If answered yes to learning disability, please list ALL learning disabilities. This information is to assist us in forming your teen by adapting the material. Your privacy will be respected.
My teen has a medical condition*
No
Yes
If answered yes to medical condition, please list ALL medical conditions
Please list any special accommodations that your teen may need
Ninth Teen's Name
First Name*
Last Name*
Select Gender
Teen's Date of Birth*
Date of Birth
Ninth Teen's Information
Teen's Cell Phone # (if they do not have their own cell phone, enter none) *
Teen's Email (if teens does not have their own email, type none) *
School Attending *
Grade Level for Fall 2025-2026*
My parish of registration is:*
Our Lady of Grace
Saint Benedict
Other
If other, what is your parish of registration?
Sacraments my teen HAS ALREADY received (check all that apply) *
Baptism
First Holy Communion
Confirmation
None
My teen has a food allergy*
No
Yes
If answered yes to food allergy, please list/describe the allergy and be specific. (i.e.: Milk allergy: can eat food with milk in it; cannot drink glass of milk)
My teen has a non-food allergy:*
No
Yes
If yes, please list the allergy/allergies:
My teen has a learning disability*
No
Yes
If answered yes to learning disability, please list ALL learning disabilities. This information is to assist us in forming your teen by adapting the material. Your privacy will be respected.
My teen has a medical condition*
No
Yes
If answered yes to medical condition, please list ALL medical conditions
Please list any special accommodations that your teen may need
Tenth Teen's Name
First Name*
Last Name*
Select Gender
Teen's Date of Birth*
Date of Birth
Tenth Teen's Information
Teen's Cell Phone # (if they do not have their own cell phone, enter none) *
Teen's Email (if teens does not have their own email, type none) *
School Attending *
Grade Level for Fall 2025-2026*
My parish of registration is:*
Our Lady of Grace
Saint Benedict
Other
If other, what is your parish of registration?
Sacraments my teen HAS ALREADY received (check all that apply) *
Baptism
First Holy Communion
Confirmation
None
My teen has a food allergy*
No
Yes
If answered yes to food allergy, please list/describe the allergy and be specific. (i.e.: Milk allergy: can eat food with milk in it; cannot drink glass of milk)
My teen has a non-food allergy:*
No
Yes
If yes, please list the allergy/allergies:
My teen has a learning disability*
No
Yes
If answered yes to learning disability, please list ALL learning disabilities. This information is to assist us in forming your teen by adapting the material. Your privacy will be respected.
My teen has a medical condition*
No
Yes
If answered yes to medical condition, please list ALL medical conditions
Please list any special accommodations that your teen may need
Parent or Guardian's Email Address
Email*
Confirm Email*
Insurance
Insurance Carrier*
Insurance Policy Number*
Primary Contact
First Name *
Last Name *
Address *
Email *
Primary Phone Number *
This number is a*
Secondary Phone Number (if you have one)
This number is a
The primary contact is the teen's*
Secondary Contact
First Name *
Last Name *
Address (if different from the Primary Guardian)
Email *
Primary Phone Number *
This number is a *
Secondary Phone Number
This number is a
The secondary contact is the teen's*
FAMILY INFORMATION: Custody/Divorce/Separation Situations
Are the teen's parents divorced?*
No
Yes
If you answered yes, what is the teen's primary address?
Are there any concerns/situations that we should be aware of pertaining to the safety/security of this 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)
Are you a parent/guardian interested in helping?
I would like to.....(please check all that apply)
be Small Group Leader for MSYM
be Small Group Helper for MSYM
help setup/serve snacks for MSYM
provide snacks for MSYM
be Small Group Leader for HSYM
be Small Group Helper for HSYM
help setup/serve snacks for HSYM
provide snacks for HSYM
Who is interested in helping?
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Emergency Contact's Relation to Participant

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*
Select Gender
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information
Teen's Cell Phone # (if they do not have their own cell phone, enter none) *
Teen's Email (if teens does not have their own email, type none) *
School Attending *
Grade Level for Fall 2025-2026*
My parish of registration is:*
Our Lady of Grace
Saint Benedict
Other
If other, what is your parish of registration?
Sacraments my teen HAS ALREADY received (check all that apply) *
Baptism
First Holy Communion
Confirmation
None
My teen has a food allergy*
No
Yes
If answered yes to food allergy, please list/describe the allergy and be specific. (i.e.: Milk allergy: can eat food with milk in it; cannot drink glass of milk)
My teen has a non-food allergy:*
No
Yes
If yes, please list the allergy/allergies:
My teen has a learning disability*
No
Yes
If answered yes to learning disability, please list ALL learning disabilities. This information is to assist us in forming your teen by adapting the material. Your privacy will be respected.
My teen has a medical condition*
No
Yes
If answered yes to medical condition, please list ALL medical conditions
Please list any special accommodations that your teen may need
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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