UCB Children and Youth Program's Registration Form 2021-2022
Welcome to UCB’s Children and Youth Ministries! Please take your time and carefully complete this form for EVERY child/youth (through grade 12) participating in the program. It will help us in our efforts to provide a meaningful, fun and safe program for all our children and youth.

Questions? Please contact Dawn MacKechnie, Director of Children and Youth Ministries: DCYM@barnstableuu.org. Thank you!

*Required
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Parent/Guardian #1 Name (last, first, middle initial) *
Parent/Guardian #1 Address: City, State, Zip *
Parent/Guardian #1 Preferred phone number *
Please indicate if this is a cell phone number and can receive text messages
Parent/Guardian #1 email address *
Parent/Guardian #1 preferred method of contact *
Parent/Guardian #2 Name (last, first, middle initial)
Parent/Guardian #2 Address: City, State, Zip
Parent/Guardian #2 Preferred phone number
Parent/Guardian #2 email address
Parent/Guardian #2 preferred method of contact
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Child/Youth #1 Name (last, first, middle initial) *
Child/Youth #1 Date of Birth *
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Child/Youth #1 Grade (if applicable) as of September 2021 *
Child/Youth #1 Does the child have allergies to substances, food or drugs that we should be aware of? If so, please list here: *
Child/Youth #1 Does the child have emotional or physical differences that would be helpful for our staff and teachers to understand (on a confidential basis)? If so, please indicate here:
Child/Youth #1 Is your child/youth vaccinated against COVID-19? *
Child/Youth #2 Name (last, first, middle initial)
Child/Youth #2 Date of Birth
MM
/
DD
/
YYYY
Child/Youth #1 Grade (if applicable) as of September 2021
Child/Youth #2 Does the child have allergies to substances, food or drugs that we should be aware of? If so, please list here:
Child/Youth #2 Does the child have emotional or physical differences that would be helpful for our staff and teachers to understand, on a confidential basis? If so, please indicate here:
Child/Youth #2 Is your child/youth vaccinated against COVID-19?
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PHOTO PERMISSIONS: Photos are a way to share the beauty of what we do! It is our practice to NOT identify children and youth in these photos. I give permission for photographs of my child to be used on social media, website, slide show, brochure…etc *
THE GREAT OUTDOORS: At times, weather permitting, we will go outside and take advantage of all nature can offer us! I give my permission for my child to go outside with the group (always with 2 adults). I understand the group will return by the end of worship. *
Additional information: Is there additional information you would like to add? Please do so here - and thank you!
SHARE YOUR GIFTS! We are Co-Creators of this Ministry with Children and Youth. The Children and Youth Program at UCB is a Co-Creative Program, and we ask all parents and guardians to actively participate! It is our expectation that parents will serve as Sunday Morning Support People each year to support the program and to get to know our children, youth and families. We also encourage all families to become members of the UCB and support our program through pledging. Please see the list below and check off the ways you’d like to share your gifts, serve this community and shine in the Children and Youth Program this year. Keep in mind that this is a fun part that helps build community!!! *
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