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Unitarian Universalist Fellowship of Poughkeepsie Family Registration Form for Religious Education
For safety and administrative reasons, the RE Committee asks that you complete this registration form. Only one form is needed per family. Please complete and submit online. If you prefer to hand-write the form, a printable form is available online at http://www.uupok.org. Blank copies are available from the RE Office, just complete and return to Lara Weisman (Children's Religious Exploration Coordinator) or any member of the LFD Committee. Please notify Lara Weisman of any special needs or concerns so that we may ensure your child will have a positive and meaningful experience in our program.
Thank you,
LFD Committee
Child #1 - Last Name *
Child #1 - First Name *
Please list your child's allergies (food or environmental): *
If so, what do we need to know about management? *
Child #1 - Age today *
Parent/Guardian #1 - Last Name *
Parent/Guardian #1 - First Name *
Parent/Guardian #1 - Street Address *
Parent/Guardian #1 - City *
Parent/Guardian #1 - Zip Code *
Parent/Guardian #1 - Home Phone *
Parent/Guardian #1 - Cell Phone *
Parent/Guardian #1 - Work Phone
Parent/Guardian #1 - Email *
Parent/Guardian #2 - Last Name
Parent/Guardian #2 - First Name
Parent/Guardian #2 - Street Address
Parent/Guardian #2 - City
Parent/Guardian #2 - Zip Code
Parent/Guardian #2 - Work Phone
Parent/Guardian #2 - Home Phone
Parent/Guardian #2 - Cell Phone
Parent/Guardian #2 - Email
Children live with: *
Child #1 - Birthdate *
MM
/
DD
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YYYY
Child #1 - Grade as of September 8, 2015 *
Child #1 - Name of school district or private school (if homeschooled, please indicate.)
This helps us plan our RE Calendar.
Child #2 - Last Name
Child #2 - First Name
Please list your child's allergies (food or environmental):
If allergies are listed above, what do we need to know about management?
Child #2 - Birthdate
MM
/
DD
/
YYYY
Child #2 - Age today
Child #2 - Grade as of September 8, 2015
Child #2 - Name of School District or Private School (if homeschooled, please indicate.)
This helps us plan our RE Calendar.
Child #3 - Last Name
Child #3 - First Name
Please list your child's allergies (food or environmental):
If allergies are listed above, what do we need to know about management?
Child #3 - Birthdate
MM
/
DD
/
YYYY
Child #3 - Age today
Child #3 - Grade as of September 8. 2015
Name of public school district or private school (if homeschooled, please indicate.)
This helps us plan our RE Calendar.
Child #4 - Last Name
Child #4 - First Name
Please list your child's allergies (food or environmental):
If allergies are listed above, what do we need to know about management?
Child #4 - Birthdate
MM
/
DD
/
YYYY
Child #4 - Age today
Child #4 - Grade as of September 8, 2015
Child #4 - Name of School District of Private School (if homeschooled, please indicate.)
This helps us plan our RE Calendar.
Have you completed the Insurance Information and Waiver Form? *
Required
Photo Permission *
Please check the YES box if you give the Religious Education Program permission to use your child(ren)'s photographs in various publications created by and for Unitarian Universalist Fellowship of Poughkeepsie. Please note: We will include the first name of the child with photos.
Additional Information
In this box, please add anything you want our Religious Education Instructors to know, i.e., developmental issues, gender identity, or any other personal concerns. This helps us meet the needs of your child(ren). If you would prefer to share this information in person, please indicate and our Children's Religious Exploration Coordinator will contact you.
The Religious Education Program is run entirely by volunteers. Are you willing to volunteer your time to this valuable program?
In what capacity would you volunteer?
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