All Saints Youth Ministry Middle School Registration

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Please note there is a $50 registration fee (payable securely online or via check). This fee helps to defray the costs of supplies & materials for youth group events. Although registration is required, we would never want costs to deter youth from participating. If you need assistance, please do not hesitate to contact Lynn Pechiney, Program Coordinator.

Please fill out all required fields marked with an asterisk (*).

EARLY BIRD DISCOUNT: Save $10 off your registration if you register before midnight June 30! Your registration is only $40 if you register before that time.

Please fill out all required fields marked with an asterisk (*).

HALF-PRICE DISCOUNT: Because we are nearing the end of our current school year, you can save 50% off our current year’s registration. Your registration is only $25 when you register today!

Please fill out all required fields marked with an asterisk (*).

NOTE ABOUT PAYMENT: If you think you may have already registered, please check your email for a “Thank You” message from [email protected]. In the event of double registration or cancellation, any refund issued will be charged a 3.5% processing fee.

Student Information

Student Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Student Cell Phone

Student Email Address

Enter Email Confirm Email

Date of Birth*

Gender*

Male

Female

T-Shirt Size*

Small

Medium

Large

Extra Large

2XL

2024-2025 Grade Level*

School You Attend*

Do you have any medical conditions we should know about?

Your Participation

Here are all of the exciting programs you can participant in with All Saints Middle School Ministry:

• MANIA: An exciting program filled with games, praise, faith, fun, socializing, food, sports and activities, tasty food, prayer with scripture, making new friends, and bringing along your current friends

• MONTHLY OUTINGS: Fun monthly adventures like corn mazes, laser tag, mini-golf, bowling, movies, and more

• MIDDLE SCHOOL MISSION: Based on the High School Work Camp, this offers you a chance to make new friends, experience new things, and have lots of fun, while learning about and sharing your faith in the context of community service

Plus other fun, faith-filled experiences!

Parent/Guardian Information

Parent/Guardian Name*

First Last

Parent/Guardian Email Address*

Enter Email Confirm Email

Parent/Guardian Cell Phone*

Parent/Guardian Work Phone

Relationship to teen?*

Mother

Father

Other

Additional parent/guardian?*

Yes

Additional Parent/Guardian Name

First Last

Additional Parent/Guardian Email Address

Enter Email Confirm Email

Additional Parent/Guardian Work Phone

Additional Parent/Guardian Cell Phone

Relationship to teen?

Mother

Father

Other

Parent Volunteer Opportunities

Are You Virtus-Certified?*

Yes

(Virtus is a training program required by, and provided by, the Diocese for all volunteers 18 and over. It is designed to create the safest possible environment for our young people.)

In order to make the All Saints Youth Ministry program a success, we need parental help.

Please sign up below for areas where you can assist. Just check the boxes.

MIDDLE SCHOOL PROGRAMS

Shepherd (aka Middle School Mania Chaperone)
Help as an extra supervisor during Friday night activities to assist our leaders.

RELEASE FORMS

Medical Release

I agree to indemnify the All Saints Parish, Youth Ministers, Volunteers, and the Diocese of Arlington for any costs or expenses arising out of my child’s participation in the activities including the cost of any medical care given my child or any expenses or fees incurred in any lawsuit arising as a result of any damage or injuries caused by my child in the course of his or her participation in the activity. I further give my consent to that in my absence the previously-named minor be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the previously-named minor. I have not been given a guarantee as to the results of examination or treatment. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above-named minor.

Parent/Guardian Medical Release Signature:*

Please sign in the box above using your mouse (or your finger if you’re on a tablet).

Print Your Name for Medical Release:*

In case of an emergency and if treatment is needed:*

You may treat my child immediately without contacting me first.

Please attempt to contact me first before treatment.

Catholic Diocese of Arlington Photo, Press, Audio & Electronic Media Release

I authorize the Catholic Diocese of Arlington, its parishes and/or schools to use and publish the photographs and/or motion picture of videotape for which my son/daughter has posed, and/or audio recordings made of her or her voice. I agree that the Catholic Diocese of Arlington, its parishes and/or schools may use such photographs of my son/daughter with or without his or her name and for any lawful purpose, including, for example, such purposes as publicity, illustration, bulletin, and Web content.

Parent/Guardian Media Release Signature:

Please sign in the box above using your mouse (or your finger if you’re on a tablet).

Print Your Name for Media Release:

Registration Fee

Our online payment system is 100% safe and secure. We do NOT store any of your credit card information. We respect your privacy!

You can save time and 100% complete your registration today as it costs you nothing extra to register online!

Can you save time and pay the registration fee securely online right now?*

Yes, I’ll save myself time and pay safely right now!

No, I’ll give you a check. (please choose if you need to defer payment at this time)

(Our online payment system is 100% safe and secure. We do NOT store any of your credit card information. We respect your privacy!)

Middle School Registration Fee*

Price:

Billing Details

Credit Card*

Card Details

Cardholder Name

Billing Address*

Street Address Address Line 2 City State ZIP Code

Total:

Check Payment

Please make your check payable to “All Saints Youth Ministry”

Drop off in person: All Saints School or Parish Office.

Or mail to: All Saints Youth Ministry, 9300 Stonewall Rd, Manassas, VA 20110

Total Due:

2024-2025 Middle School Ministry Registration

Student Information

Your Participation

Parent/Guardian Information

Parent Volunteer Opportunities

RELEASE FORMS

Medical Release

Catholic Diocese of Arlington Photo, Press, Audio & Electronic Media Release

Registration Fee

Billing Details

Check Payment

CONNECT

Programs

Volunteer

PAYMENTS