registration for children's and youth RE program

Child's Name

Child's Pronouns

Date of Birth

School Grade

Expected Attendance almost always sometimes seasonal

Dietary Needs Vegan Gluten Free Nut Free None

Allergies or Medical Needs

Optional

Are there any special situations or needs your child has or that we should be aware of? If necessary, please contact the DRE so we can make accommodations for your child.

Optional

Parent(s)/Guardian(s) Name(s)

Home Phone

Optional

Cell Phone

Address

Emergency Contact

Relationship

Optional

Phone

Photo/Video Permission

Students must have parental permission to be photographed/videotaped and to appear in any UUFCO publications and on the UUFCO web site. No student’s name, street address, email address, or phone number will be published.

I grant permission for UUFCO to photograph or videotape my child(ren) in class and at fellowship events and to use my student’s picture in publications, on bulletin boards, and on the UUFCO website or Internet

RE Program Participation

I/We, being the legal parent(s)/guardian(s) of do hereby give permission to UUFCO for said child to participate in the RE Program and related fieldtrips during the 2016-17 church year. I/We do hereby release and discharge UUFCO from any liability of claim or cause of action that I may now have, or may have in the future, as a result of any injuries received by the said child(ren) while s/he/they participates in any activities and/or fieldtrips. Furthermore, in the event of an accident, I understand that an attempt will be made to contact me at the phone numbers provided on the Registration Form. If the emergency contact, or I, cannot be reached in time, I hereby authorize the administration of emergency medical aid to my child(ren). I agree to accept financial responsibility for any and all emergency medical care so provided.

Parent/Guardian Name

Date

Description

Please fill out this form and click submit.

registration for children's and youth RE program

Description

Please Fix the Following