2024-2025 High School Youth Ministry Registration "*" indicates required fields Step 1 of 3 33% Student InformationPlease note there is a $75 registration fee (payable 100% securely online or via check). This fee helps to defray the costs of supplies, materials and all meals for Sunday night youth group events. Although registration is required, we never want money to stand in the way of youth participating, if you need assistance, please do not hesitate to contact Lynn Pechiney, our Program Coordinator. Please fill out all required fields marked with an asterisk (*).Please note there is a $75 registration fee (payable 100% securely online or via check). This fee helps to defray the costs of supplies, materials and all meals for Sunday night youth group events. Although registration is required, we never want money to stand in the way of youth participating, if you need assistance, please do not hesitate to contact Lynn Pechiney, Program Coordinator. EARLY BIRD DISCOUNT: Save $10 off your registration if you register before midnight June 30! Your registration is only $65 if you register before that time. Please fill out all required fields marked with an asterisk (*).Please note there is a $75 registration fee (payable 100% securely online or via check). This fee helps to defray the costs of supplies, materials and all meals for Sunday night youth group events. Although registration is required, we never want money to stand in the way of youth participating, if you need assistance, please do not hesitate to contact Lynn Pechiney, Program Coordinator. 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 $37.50 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 Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone* Student Cell Phone Student Email* Enter Email Confirm Email (Please enter your email in each box above so we make sure there are no typos.)Date of Birth*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender* Male Female T-Shirt Size* Small Medium Large Extra Large 2XL Anticipated High School Graduation Year* School You Attend* Do you have any medical conditions we should know about?Your ParticipationHere are all of the exciting programs you can participant in with All Saints High School Ministry: • Sunday Night Life Teen • Catholic Life Communities (for Boys and Girls) • What’s Up Wednesdays • St. Gianna’s Life Defenders Club • Deeper • Unleashed • Summer Mission and Workcamp • Upper Room Theatre Ministry • Fall Retreat Plus other fun outings, trips, and more! Parent/Guardian InformationParent/Guardian Name* First Last Parent/Guardian Email Address* Enter Email Confirm Email (Please enter your email in each box above so we make sure there are no typos.)Parent/Guardian Work Phone Parent/Guardian Cell Phone* Relationship to teen?* Mother Father Other Additional parent/guardian?* Yes No Additional Parent/Guardian Name First Last Additional Parent/Guardian Email Address Enter Email Confirm Email (Please enter your email in each box above so we make sure there are no typos.)Additional Parent/Guardian Work Phone Additional Parent/Guardian Cell Phone Relationship to teen? Mother Father Other Parent Volunteer InformationParent involvement is necessary in order to maintain the success of this large program. Volunteer opportunities will be emailed to you at a later date for sign up through our “Meal Train” service. Most volunteer opportunities require Virtus compliance. Are You Virtus-Certified?* Yes No (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.)RELEASE FORMSMedical ReleaseI 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 ReleaseI 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 FeeOur 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!Would you like to save time & pay the registration fee online right now?* Yes, I’ll pay right now! No, I’ll give you a check. (Please choose if you need to defer payment at this time) Billing DetailsCredit Card*Card Details Cardholder Name Billing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Check PaymentPlease make your check payable to “All Saints Youth Ministry” Drop off in person: All Saints School or Parish Office. Or mail to: All Saints Catholic Church, Attn: Youth Ministry, 9300 Stonewall Rd, Manassas, VA 20110High School Registration Fee Price: Total: Δ