Faith Formation Registration 2021-2022
This form will be required for all children and youth who will be attending UUCR's Faith Formation classes and outings during the 2021-2022 church year.
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First Child's Information
School Grade as of September 2021
Strengths, Interests and Hobbies of Child/Youth
Health & Safety Information
Your responses to the following questions helps us to assure your child's safety and well-being while with us in UUCR activities in the buildings, and on and off the grounds. This information is shared only with those who need it, such as the RE staff, your child's teachers and trip chaperones.
Seafood and Shellfish
Peanuts and Tree Nuts
Social/emotional/neurological differences- Please check all that apply
ASD (Autism Spectrum Disorder)
Learning Disability Diagnosis
Deaf/hard of hearing
Uses wheelchair or other mobility aid
If you answered yes to either or both of the last two questions to what teaching styles/ accommodations does your child/youth respond best?
Emergency Contact Name ( non-parent)
Emergency Contact Phone
Doctor's Phone Number
Insurance Card Holder
Insurance Policy or ID Number
Insurance Phone Number
Would you like to meet with the DRE to discuss your child/youth's needs?
Images, including individual and group photographs will not be used in publications created by/for UUCR without the permission of the parent/guardian. This pertains to images used on the
website, email correspondence, congregational brochures/posters and on bulletin boards located in the church buildings. Answering "Yes" means you grant permission for photos of your child taken during UUCR events/activities to be published on the church website, church-only emails, and congregational brochures/posters or in the church building. No names will be attached.
I have read and agree to the information above.
This is my only Child
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This form was created inside of Unitarian Universalist Congregation of Rockville.