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Youth Registration

- Youth / Young Adults

St. Matthias Parish Youth Registration Form

For ALL children participating in any Parish programs/events
*Use this form to register teens/preteens and preschoolers (younger than grade 1)
and friends of St. Matthias students,
who are not registered for CCD or as a CCD Teen Helper
or at St. Ann Preschool in 2021-22.

The information below is confidential and needed for parish records.
Please use LEGAL names. Thank you.

OR click here for the Youth Registration Form (hard copy) to print out (if not completing online) and return completed form ASAP by mail to: St. Matthias Parish, Attn: Linette Kerr, 408 S Route 88, Carmichaels, PA 15320
OR return by email at linettekerr@windstream.net.
The maximum number of form submissions has been reached. This form is currently not available.
- Child's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Grade Entering REQUIRED Please fill out this field. Please enter valid data.
  
  School Attending REQUIRED Please fill out this field. Please enter valid data.
  
  For additional child:
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender
  
  Date of Birth Please enter a date.
  
  Grade Entering Please enter valid data.
  
  For 3 or more children, please submit another form as needed.
  
  Medical Conditions / Food Allergies
  
  There is NO nurse or medical personnel onsite during Parish events. Please note if child carries an EPI-pen or other medications. Complete the following forms: "Parent Reuqest for Administration of Medication and Agreement of Release" and "Physician's Instructions concerning Medication Given at Parsh Religious Education Program" from the Diocese of Pittsburgh and return to St. Matthias Parish Religious Education County Coordinator, Linette Kerr, at linettekerr@windstream.net.
  
  If child has a special diet & there is a special event/holiday celebration, please pack his/her own snack. Thank you.
- Parent / Guardian's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relationship to child if NOT parent (i.e. grandparent) Please enter valid data.
  
  Street REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Type REQUIRED Please fill out this field.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Type
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Church/Parish Member(s) of: Please enter valid data.
- Emergency Contact (if unable to reach parent)
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Relationship to child REQUIRED Please fill out this field. Please enter valid data.
- Person picking up child (if not parent)
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Relationship to child Please enter valid data.
- Additional Information
- Photo Release
  
  I give permission for my child/children to be photographed / video recorded and to use his/her name(s) in any printed or online publications by St. Matthias Parish and/or Pittsburgh Diocese. REQUIRED Yes No Please fill out this field.
- Online Release
  
  I give permission for my child/children to participate in Zoom/Online classes by St. Matthias Parish. REQUIRED Yes No Please fill out this field.
- COVID Memo
  
  ~ COVID-19 symptoms & temperature screenings are be done by ALL parents/guardians at HOME before Parish events.
  
  ~ NO child with symptoms should be brought to Parish events. For more information on COVID-19, visit websites: CDC or PA.gov or DioPitt.org.
- Important Information
- Thank you for your Christian witness and service. Please read the following policies. For questions, please contact Linette Kerr, Religious Education County Coordinator, at linettekerr@windstream.net or by phone at 724-966-7270.
  
  **Grade 6 and above CCD students are dismissed to their parents. If a parent has not arrived, student should return to the event area/church and wait with his/her Parish Youth Leader/volunteer/staff.
  
  Diocesan Youth Policy (S II, III, V)
  “Social Networking is not permitted for use with minors…
  
  Email and Text Messaging is not permitted for use with minors…
  
  At no time is one-on-one video or chat room interaction appropriate between adults and minors.”
  **Parents are the main contact persons for their children with the Parish Youth Leader/volunteer/staff.
  Please contact Linette Kerr ASAP to report any concerns. Thank you.
  
  For Safe Environment questions and/or clearance requirements, please contact Marci Snee, Safe Environment Coordinator, at saintannchurch@comcast.net or by phone at 724-627-7568.
- Release
- “In consideration for providing my child the opportunity to attend and/or participate in a Parish activity, sport, or event and any related transportation to and from the same, both my child and I voluntarily agree to waive, and discharge any and all claims against the Parish, its Governing Bodies, the individual members thereof, the Diocese of Pittsburgh, the Most Reverend David A. Zubik, Trustee, and all successors, assigns, officers, agents, employees, volunteers, and representatives and release them from liability for any exposure to or illness or injury from an infectious disease including COVID-19, including claims for any negligent actions of the Parish or its employees or agents, to the fullest extent allowed by law, for myself, my child, our estates, our heirs, our administrators, our executors, our assignees, and our successors .”
  I Agree Please select this field.
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