UUCC Lifespan Faith Development 2017-2018 Children and Youth Registration Form
Children and youth Sunday school, nursery-12th grade.
Contact Information
Primary contact parent/guardian full name *
Your answer
Primary contact's relationship to the child *
Primary contact's preferred phone *
If you would like to list 2 numbers (Ex: Cell and Home) please separate numbers with a comma.
Your answer
Primary contact's preferred email address *
Your answer
Mailing address *
Your answer
Second parent/guardian's full name (or emergency contact) *
Your answer
Secondary contact's relationship to the child *
Secondary contact's preferred phone *
If you would like to list 2 numbers (Ex: Cell and Home) please separate numbers with a comma.
Your answer
Secondary contact's preferred email address
Only complete if secondary contact would like to recieve emails with information and instruction for upcoming events.
Your answer
Is this a new or renewal registration? *
Child(ren)'s Information
Once information for all children in family has been entered, skip to the next section.
1st Child's full name *
Your answer
1st Child's Date of Birth *
MM
/
DD
/
YYYY
1st Child's grade as of September 2017 *
Identifying gender *
Does this child have any allergies or special needs we need to be aware of? *
ex: "allergic to nuts" or "gluten intolerant" or "has diagnosis of ADHD", ect... If none write "none"
Your answer
2nd Child's full name
Your answer
2nd Child's date of birth
MM
/
DD
/
YYYY
2nd Child's grade as of September 2017
2nd Child's identifying gender
Does this child have any allergies or special needs we need to be aware of?
Ex. "allergic to nuts" or "gluten intolerant" or "has a diagnosis of ADHD", etc... If no allergies or special needs please write, "none"
Your answer
3rd Child's full name
Your answer
3rd Child's date of birth
MM
/
DD
/
YYYY
3rd child's grade as of September 2017
Does this child have any allergies or special needs we need to be aware of?
Ex: "allergic to nuts" or "gluten intolerant" or "has a diagnosis of ADHD", etc... If no allergies or special needs please write, "none"
Your answer
4th Child's full name
Your answer
4th Child's date of birth
MM
/
DD
/
YYYY
4th Child's grade as of September 2017
4th Child's identifying gender
Does this child have any allergies or special needs we need to be aware of?
Ex. "allergic to nuts" or "gluten intolerant" or "has diagnosis of ADHD", etc... If no allergies or special needs please write, "none"
Your answer
5th Child's full name
Your answer
5th Child's date of birth
MM
/
DD
/
YYYY
5th Child's grade as of September 2017
5th Child's identifying gender
Does this child have any allergies or special needs we need to be aware of?
Ex: "allergic to nuts" or "gluten intolerant" or "has diagnosis of ADHD", etc... If no allergies or special needs please write, "none"
Your answer
6th Child's full name
Your answer
6th Child's date of birth
MM
/
DD
/
YYYY
6th Child's grade as of September 2017
6th Child's identifying gender
Does this child have any allergies or special needs we need to be aware of?
Ex: "allergic to nuts" or "gluten intolerant" or "has diagnosis of ADHD", etc... If no allergies or special needs please write, "none"
Your answer
Volunteer
There is no charge for our Children and Youth Programs, but families are asked to support the church and its programs through a pledge or regular gifts as well as through active participation in the Children and Family Ministry programs. Ours is a cooperative, volunteer-led Religious Education program. We count on participation of each family to continue to offer vibrant programs. How can we count you in?
Volunteer Opportunities *
Please select 1 or 2 options. All volunteers working directly with children must complete backgroundcheck.
Required
Authorizations
Media Release *
Photographs and/or videos of my child(ren) may be posted on the UUCC website, Facebook pages and publications (no names attached).
Required
Authorization and Release *
By typing my name below as an electronic signature, I hereby grant permission and medical release for my child or ward named above to participate in activities sponsored by the Unitarian Universalist Church of Cheyenne (UUCC). I release UUCC and all volunteers and employees of UUCC from any claim I or my child shall have arising out of any sponsored activity of UUCC. I recognize that this permission and release is valid until revoked in writing and delivered to the office of UUCC.
Your answer
Would you like to be added to our private UUCC Faith Development Facebook Group?
If yes, please type facebook alias below. If no, or are already a part of our group, skip this question.
Your answer
Submit
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