REQUIRED: Diocesan Youth Agreement Form
Please read the following agreement for youth ministry participants:
Assumption of Risk
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.
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, fully and forever to release, defend, indemnify, and hold harmless the Catholic
Date: 2
Diocese of Arlington, the 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 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.
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 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.
Need to Inform and Quarantine
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.
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 canceled or administered via electronic media, I will not be entitled to a
refund of any of my fees.
