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HIGH SCHOOL
MIDDLE SCHOOL
THEATRE
PAYMENTS
- Pay for an Activity
- Make a Donation
ABOUT US
CONNECT
COVID-19

2021-2022 High School Youth Ministry Registration

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Student Information
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.

(To download a registration form in Spanish, click here.)

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.

(To download a registration form in Spanish, click here.)

Please fill out all required fields marked with an asterisk (*).
Student Name*
First Last
Address*
Street Address Address Line 2 City 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*
Anticipated High School Graduation Year*
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 High School Ministry:
• Sunday Night Life Teen
• Catholic Life Communities (for Boys and Girls)
• What's Up Wednesdays
• Lunch Bunch
• 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 Information
Parent/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
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
Parent Volunteer Information
Parent 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 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 Signature:*
Please sign in the box above using your mouse (or your finger if you're on a tablet).
Print Your Name:*
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 Signature:
Please sign in the box above using your mouse (or your finger if you're on a tablet).
Print Your Name:

COVID-19 Required Agreement for Youth Ministry Participants
Because of our current pandemic, all youth ministry participants are required to have a signed agreement on file.

Parents/legal guardians, please read, fill out, and sign the agreement below. Thank you for your understanding!
Parish Name: All Saints Catholic Church
Parish Name
Event Name: 2021-2022 Youth Ministry Activities
Event Name
Awareness of Risk
The novel coronavirus, COVID-19, has been declared a worldwide pandemic and is contagious. As a result, in order to resume Youth Ministry activities (“Youth Ministry”), the Catholic Diocese of Arlington has established essential health and safety measures at the Catholic parish named above ("Parish"). The Parish has put in place reasonable preventative measures and standards of behavior, consistent with guidelines issued by the Centers for Disease Control and Prevention (“CDC”) and state and local public health guidance, to reduce the spread of COVID-19 in Youth Ministry activities. Even with implementation of health and safety protocols, however, the Diocese and Parish cannot guarantee that you or your child(ren) will not become infected with COVID-19, and participation in Youth Ministry activities could increase your risk and/or your child(ren)'s risk of contracting COVID-19. Any interaction with others includes possible exposure to, and illness from, communicable diseases including COVID-19 and influenza.

I understand that Youth Ministry activities are not mandatory. By returning to in-person Youth Ministry activities, I give my informed consent for me or my child(ren) to participate and assume responsibility for the above-noted risks.

I willingly agree that my child(ren) and/or I will comply with the health and safety protocols established by the Parish, and will take all reasonable and necessary additional precautions to protect against communicable diseases while on Parish premises, not only for our own benefit but for the benefit of others with whom we may come into contact. We agree that, if we observe any objects, practices or procedures we believe to be hazardous while on Parish premises, we will remove ourselves from the location of such hazard and bring it to the attention of Parish administration immediately.
Liability Waiver
By signing this agreement, I acknowledge the contagious nature of COVID-19 and that my child(ren) and/or I may be exposed to or infected by COVID-19 by participating in in-person Youth Ministry activities, and that such exposure or infection may result in personal injury, illness, permanent disability, and/or death. I understand that the risk of becoming exposed to or infected by COVID-19 at the above-named Parish may result from the actions, omissions, or negligence of myself, my child(ren) or others, including, but not limited to Diocesan or Parish administrators, employees, volunteers, and other program participants and their families.

I further agree on behalf of myself and/or my child(ren) named herein, and our respective heirs, successors, and assigns, to fully and forever release, defend, indemnify, and hold harmless the Catholic Diocese of Arlington, the named Parish, their clergy, administrators, employees, agents, members and volunteers ("Indemnitees") from any and all claims, damages, demands, and causes of action, present or future, known or unknown, anticipated or unanticipated, in any way related to exposure to COVID-19 while participating in Youth Ministry activities, including but not limited to any claims of negligent exposure. This includes claims that arise from my own and others’ acts, actions, activities and/or omissions, excepting only those which arise solely from the gross negligence, recklessness or intentional torts of Indemnitees. I will defend and indemnify Indemnitees with respect to any released claim, including but not limited to damages, costs and attorney’s fees.
Responsibility for Health Screening
By execution of this Statement, I affirm that my or my child(ren)’s presence at named Parish on any day constitutes an affirmative representation on my part that I/we have performed the required health screening below and affirm that the responses to all questions are NO.

SCREENING QUESTIONS

“YES or NO, neither I nor my child(ren) have any of the following:”

• A fever of 100.4°F (38°C) or higher or a sense of having a fever during the past 72 hours
• New or unexpected cough that cannot be attributed to another health condition
• New shortness of breath or difficulty breathing that cannot be attributed to another health condition
• New chills that cannot be attributed to another health condition
• A new sore throat that cannot be attributed to another health condition
• New muscle aches that cannot be attributed to another health condition or specific activity (such as physical exercise)
• New loss of taste or smell
• Nausea, vomiting or diarrhea
• Currently living with a person who has exhibited symptoms of COVID-19 or is currently under quarantine due to close contact with a person suspected or confirmed to have COVID-19

“YES or NO, in the past 14 days, neither I nor my child(ren) have done any of the following:”

• Cared for or had other close contact with a person suspected or confirmed to have COVID-19
• Travelled internationally

I understand that on any day when anyone in our household answers YES to any of the required health screening questions above, I and/or my child(ren) are not permitted to participate in in-person Youth Ministry activities.
Need to Inform and Quarantine
I further understand, in the event that I/my child is suspected or confirmed positive with COVID-19 or has come in close contact with a person suspected or confirmed positive with COVID-19, I/my child will need to follow the CDC’s guidance for isolation or quarantine as appropriate. Information is available at www.cdc.gov. I agree to inform the Parish administration as soon as possible, but no later than 1 business day, after learning of my/my child’s suspected or confirmed positive case of COVID-19 and/or the need to quarantine due to close contact with a person suspected or confirmed positive for COVID-19.

I understand that I/my child may not return to in-person Youth Ministry activities until approved by Parish Administration. Approval will be based on confirmation that the CDC's criteria to discontinue home isolation or quarantine has been met. For details reference:

For those suspected or confirmed positive: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/end-home-isolation.html

For those quarantining due to close contact: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html
Authorization and Informed Consent
I hereby authorize the Parish to enforce such other reasonable measures and directives as may be deemed necessary by the Bishop of the Diocese of Arlington, its Office of Youth, Campus, and Young Adult Ministries or the Parish leadership. I further understand that, in the event that it becomes necessary that events or programs should be cancelled or administered via electronic media, I will not be entitled to a refund of any of my fees.

This Agreement has been prepared in the English language, and the English version thereof shall prevail and be binding in the event of any inconsistency even though a Spanish or other language translation may also be prepared.

By execution of this Statement, I understand and agree to the foregoing terms and conditions.
Parent/Legal Guardian Signature*
Type Your Full Legal Name*
Today's Date*
Date Format: MM slash DD slash YYYY

Registration Fee
As a reminder, 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.

SAVE $10 IF YOU REGISTER BEFORE MIDNIGHT JUNE 30 -- YOUR REGISTRATION IS ONLY $65!

Our online payment system is 100% safe and secure - you can save time and 100% complete your registration today! It costs you nothing extra to register online!
As a reminder, 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.

Our online payment system is 100% safe and secure - you can save time and 100% complete your registration today! It costs you nothing extra to register online!
(Our online payment system is 100% safe and secure. We do NOT store any of your credit card information. We respect your privacy!)
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 Details
Credit Card*

Card Details

Cardholder Name
Billing Address
Street Address Address Line 2 City State ZIP Code
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 Catholic Church, Attn: Youth Ministry, 9300 Stonewall Rd, Manassas, VA 20110
High School Registration Fee
Price: $65.00
Total:
$0.00

All Saints Catholic Church
300 Stonewall Road
Manassas, VA 20110
703-393-2141

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