Registration: Religious Education for Children and Youth 2016-2017
This form authorizes my child to participate in all Religious Education programs and activities that are on and off church property during the 2016-2017 church year. Please complete one form for EACH child or youth that you are registering.

An important note from your Religious Education Team:
Religious Education is a partnership between our educators, you as parents/guardians, and our children and youth. It works best when we are all committed and engaged. Therefore, we expect that you will make every effort to come to church and CONSISTENTLY bring your child to the religious education programs which our teaching teams have prepared. Don’t be surprised if you hear from your RE class liaison if we haven’t seen you in a couple of weeks – we care about you and your children!

Child's First Name
Your answer
Child's Last Name
Your answer
Child's Date of Birth
Your answer
Grade Level During 2016-2017 School Year
Your answer
In the event of an accident, I understand that an attempt will be made to contact me at the following numbers:
Cell Phone
Your answer
Home Phone
Your answer
Work Phone
Your answer
If I cannot be reached, call my emergency contact.
Emergency Contact Name
Your answer
Emergency Contact Phone
Your answer
If the emergency contact or I cannot be reached in time, I hereby authorize the administration of emergency medical aid to my son/daughter. In emergencies requiring immediate medical attention, my child will be taken to the nearest hospital emergency room. My signature authorizes the responsible person from the Unitarian Universalist Church of Reading conducting this activity to have my child transported to that hospital. I agree to accept financial responsibility for any and all emergency medical care so provided. I also authorize the UUCR trip supervisors to administer to my son/daughter the medications, if any, listed below on this form.
Required
I hereby authorize UUCR to use my child’s photo or video of my child, without identification, on the UUCR website or in printed materials to promote UUCR programs and activities.
Required
The Unitarian Universalist Church of Reading welcomes every child in our Religious Education programs. Because our Religious Education explorations and programs are group-centered, please share with us specific ways that we can include your child in their age-based explorations. Also, please indicate allergies (general, food, medicine), special medications, health conditions, physical or medical needs, and/or behavioral, learning or emotional concerns or issues.
Your answer
Guardian Digital Signature
Your answer
Date
MM
/
DD
/
YYYY
Email
Your answer
Address
Your answer
City/Town
Your answer
Zip Code
Your answer
Guardian #2, if applicable
Your answer
Email
Your answer
Address (if different than above)
Your answer
City/Town (if different than above)
Your answer
Zip Code (if different than above)
Your answer
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