Soulful Exploration 2018-2019 Registration (one per child)
Thank you for allowing your child(ren) or youth to participate in RE and youth programming at WUUC. In order to best serve your child(ren) and family, and to provide prompt emergency attention if necessary, we require the following information in order to have your child(ren) participate in RE. There is no fee to participate in RE and youth programming unless explicitly noted (e.g. Coming of Age, OWL, Youth CONs, etc.). Please fill out a separate form for each child (our database requires it). For questions or to provide more detailed or confidential information, please contact Office Administrator Lori Varosh, office@wuuc.org. Returning families, please complete our abbreviated update form here: https://goo.gl/forms/9dMiWREVohNIDpgI2
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First Name *
Middle Name
Last Name *
Primary Address Line 1 *
Primary Address Line 2
Primary Address City *
Primary Address Postal Code
Home Phone
(xxx) xxx-xxxx
Mobile Phone *
Work Phone
Primary Email *
Parent Email
Alternate Email
Youth's Email Address
Birthdate *
MM/DD/YY
Child Medical/Dietary Alerts
Please indicate any allergies or medical information WUUC should know. If explanation is required beyond this form, please speak with the DLL.
Family Physician and Contact *
Field Trip Permission *
I give consent for my child(ren)/youth to participate in field trips sponsored by WUUC. Field trips will be announced in advance and I can revoke this agreement on an individual basis by contacting the DLL, RE Teacher or Youth Advisor. I understand that WUUC does not accept responsibility for any bodily injury incurred during the event.
Medical Treatment *
In the event of apparent illness or injury to my child(ren)/youth, I authorize the DLL or WUUC adult sponsor to provide, at my expense, first aid or other appropriate assistance and/or to contact a local doctor in an emergency. I hereby release and absolve the Woodinville Unitarian Universalist Church, its Board of Directors, and authorized Religious Exploration staff from any claim arising out of injury to my child(ren)/youth.
Parent/Guardian Name *
Parent/Guardian Name(s)
Photo Release Approval *
May we have permission to post unnamed pictures of your child(ren) or youth on our public sites (e.g. including but not limited to the WUUC website, Facebook, Newsletter, etc.)?
Photo Release Exception
Preferred Gender Pronoun
Clear selection
Preferred Gender Pronoun Other
Or let us know here...
Grade in August/September of 2018 *
PK1=1 y.o, PK2=2 y.o, etc.
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