2022-2023 Middle School Ministry Registration

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.

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 (*).

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!

The novel coronavirus and its variants that cause COVID-19 have resulted in a worldwide pandemic and are contagious. In order to continue in-person ministry, the parish named above ("Parish") has established essential health and safety measures. The Parish has put in place precautionary measures and standards of behavior to reduce the likelihood of spread of COVID-19 in Youth Ministry activities. These measures and standards may be updated during the ministry year.

Even with the implementation of these health and safety protocols, however, the Parish and the Catholic Diocese of Arlington cannot guarantee that you or your child(ren) will not become infected with COVID-19. Attendance at the Parish 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 may result in exposure to, and illness from, communicable diseases including COVID-19.

I understand that Youth Ministry activities are not mandatory. By sending my child(ren) for 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 I will comply with the health and safety protocols established by the Parish, including any future modifications to those protocols, 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 hazards and bring it to the attention of Parish administration immediately.

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, fully and forever to release, defend, indemnify, and hold harmless the Catholic Diocese of Arlington, the School, 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 that arise solely from the gross negligence, recklessness or intentional torts of Indemnitees, and those that are both (a) not asserted by our child or family or any member thereof, and (b) not alleged to arise from our acts or omissions. With respect to claims alleged to arise from our acts or omissions, our agreement to defend, indemnify and hold harmless the Indemnitees shall be effective only in the event that I, my child, or a member of our family is determined to be liable for such acts or omissions under applicable law, or by agreement. I will defend and indemnify Indemnitees with respect to any released claim, including but not limited to damages, costs and attorney's fees.

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 all health screening steps required by the Parish for attendance or participation in Youth Ministry activities.

I understand that on any day when my child(ren) does not pass the required health screening (which may include questions relating to other members of the household as well as my child(ren)), I and/or my child(ren) are not permitted to participate in in-person Youth Ministry activities.

I 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 implemented by the Virginia Department of Health and local health departments. Information is available at www.cdc.gov. I agree to inform the Parish administration as soon as possible, but no later than one (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 by the local health department that the CDC's criteria to discontinue home isolation or quarantine has been met.

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 canceled or administered via electronic media, I will not be entitled to a refund of any of my fees.

By execution of this Statement, I understand and agree to the foregoing terms and conditions.