Registration: Religious Education for Children and Youth 2017-2018
This form authorizes my child to participate in all Religious Education programs and activities that are on and off church property during the 2017-2018 church year. Please complete one form for EACH child or youth that you are registering.

An important note from your Religious Education Team:
Religious Education is a partnership between our educators, you as parents/guardians, and our children and youth. It works best when we are all committed and engaged. Therefore, we expect that you will make every effort to come to church and CONSISTENTLY bring your child to the religious education programs which our teaching teams have prepared. Don’t be surprised if you hear from your RE class liaison if we haven’t seen you in a couple of weeks – we care about you and your children!

Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Date of Birth *
Your answer
Grade Level During 2017-2018 School Year *
Your answer
In the event of an accident, I understand that an attempt will be made to contact me at the following numbers:
Cell Phone *
Your answer
Home Phone *
Your answer
Work Phone
Your answer
If I cannot be reached, call my emergency contact.
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
If the emergency contact or I cannot be reached in time, I hereby authorize the administration of emergency medical aid to my son/daughter. In emergencies requiring immediate medical attention, my child will be taken to the nearest hospital emergency room. My signature authorizes the responsible person from the Unitarian Universalist Church of Reading conducting this activity to have my child transported to that hospital. I agree to accept financial responsibility for any and all emergency medical care so provided. I also authorize the UUCR trip supervisors to administer to my son/daughter the medications, if any, listed below on this form. *
Required
I hereby authorize UUCR to use my child’s photo or video of my child, without identification, on the UUCR website or in printed materials to promote UUCR programs and activities. *
Required
The Unitarian Universalist Church of Reading welcomes every child in our Religious Education programs. Because our Religious Education explorations and programs are group-centered, please share with us specific ways that we can include your child in their age-based explorations. Also, please indicate allergies (general, food, medicine), special medications, health conditions, physical or medical needs, and/or behavioral, learning or emotional concerns or issues.
Your answer
Guardian Digital Signature *
Your answer
Date *
MM
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DD
/
YYYY
Email *
Your answer
Address *
Your answer
City/Town *
Your answer
Zip Code *
Your answer
My signature here indicates that I am enrolling my child/ren in a cooperative Religious Education program at UUCR and that I will commit to an appropriate volunteer opportunity that supports programming for children and youth. Please check one box. *
Guardian #2, if applicable
Your answer
Email
Your answer
Address (if different than above)
Your answer
City/Town (if different than above)
Your answer
Zip Code (if different than above)
Your answer
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