Soulful Exploration 2016-2017: Safety Information Form--One Entry 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 Rev. Jamil Scott at
Primary Address Line 1
Primary Address Line 2
Primary Address City
Primary Address Postal Code
Youth's Email Address
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.
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.
Please let us know if your child is interested in participating in youth choir or helping with children/adult worship.
Helping with Worship
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.)?
Agreed with noted exceptions
Photo Release Exception
Preferred Gender Pronoun
Preferred Gender Pronoun Other
Or let us know here...
School Grade in Sept 2016
Click on the drop down list to select a "grade" relative to kindergarten (e.g. PK2 = will start kindergarten fall of 2018)
Page 1 of 1
Never submit passwords through Google Forms.
This form was created inside of Woodinville Unitarian Universalist Church.
Terms of Service