Religious Exploration Child/Youth Registration 2016-17
Please use this form to register all children, from nursery through Senior Youth.  Even if you attend only sporadically, we'd like to have safety and contact information.  

Please note that there will be no program fee for Religious Exploration, in 2016-2017.  If your family does not currently have a pledge on record for this year, we encourage you to go ahead and make a pledge, or consider raising the pledge you already make.  Our program, including salary for our professional staff, depends almost entirely on pledges, to continue operating.  The board will also be holding special collections in support of RE, during several Sunday services this year.  If your family is able to support at a higher level, we ask that you participate in those collections.

Confidentiality notice:  This form will only be seen by the Director of Religious Education.  Information you provide may be shared with teachers or other volunteers, at the DRE's discretion, to help us see that each child's needs are met.  If there is information you would like the DRE to keep confidential, please indicate that.  It is our intention to protect family privacy whenever possible.

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Parent or guardian 1 name *
Home address *
Home phone
Mobile phone
email address *
What is your preferred way to be contacted? *
Parent/guardian 2 name *
home address *
home phone
mobile phone
email address *
What is your preferred way to be contacted? *
Do you have a financial pledge on record with UUFLB for 2016-2017? (There is no fee for registering your child.  Our program is supported by the financial pledges made by our members and friends.  We cannot continue to exist without that support.) *
Child 1 name *
Child 1 Date of Birth *
Child 1 age as of September 1, 2016 *
In what class will Child 1 enroll? *
Does Child 1 have any medical or other special needs, including allergies?   *
Please describe any medical or other special needs.
Is there anything else we should know about Child 1, in order to ensure the best possible experience for your family?
Child 2 name
Child 2 Date of Birth
Child 2 age as of Sept. 1, 2016
In which class will Child 2 enroll?
Clear selection
Does Child 2 have any medical or other special needs, including allergies?
Clear selection
Please describe medical or other special needs.
Is there anything else we should know about Child 2 in order to ensure the best possible experience for your family?
Child 3 name
Child 3 Date of Birth
Child 3 age as of Sept. 1, 2016
In which class will Child 3 enroll?
Clear selection
Does Child 3 have any medical or other special needs?
Clear selection
Please describe medical or special needs.
Is there anything else we should know about Child 3, in order to ensure the best possible experience for your family?
If you are enrolling additional children, please provide each child's name, date of birth, age as of Sept. 1, the class in which each child will enroll, and detail any special needs or other concerns.
Occasionally, we will plan programming that involves going outside, on Pen Ryn's grounds or in the immediate neighborhood.  Do you give permission for your child to participate in these activities?  This includes nursery children, who may go outdoors to play.  (Permission for trips taken by car or other means, further from Pen Ryn, will be handled separately.) *
Do you wish to give permission for your child's image (without name) to be used in Fellowship-produced media such as the newsletter, e-news, Facebook page, and web page?  (Permissions for outside media will be handled separately.) *
Do you understand that supervision of your children is your responsibility, when they are on Pen Ryn grounds outside of scheduled RE-sponsored programming? *
Name of someone we may contact other than parents/guardians, in case of emergency. *
Phone number for emergency contact. *
This person's relationship to your child. *
Parent/guardian 1:  Please select as many as apply.
Parent/guardian 2:  Please select as many as apply.
This is intended as additional space for comment, in case of need.  
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