UUSE Children & Youth Ministry Registration 2023-24

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Child Information

First Name *

Last Name *

Date of Birth *

YYYY

Grade Level in Fall 2023 *

Gender *

Male

Female

Non-binary

Do we have permission to use this child's image without their name in photos and videos pertaining to UUSE and its programs? *

Yes

Are there any allergies or other concerns we should be aware of? This information is confidential. If there are none, please write "none" in the space below. *

If 6th grade or higher, what is this child's email address?

If 6th grade or higher, what is this child's cell phone number?

Street Address *

City *

State *

Other:

Zip Code *

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