UUCM Child & Youth Registration
Please fill out one form for EACH child/youth
Child/Youth Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade in School *
Your answer
Choose Your Program (s) *
Required
Child/Youth Cell Phone
Your answer
Include above phone number in UUCM Directory?
Child/Youth Email Address
Your answer
High School Youth ONLY- Do you give permission for UUCM staff and youth advisers to communicate directly with youth? *
High School Youth ONLY - please indicate preferred method of contact
Allergies/Food Restrictions *
Type "None" if not applicable
Your answer
Anything else we should know about *
Type "None" if not applicable
Your answer
Permission to publish photos of child/youth in UUCM's publications/website/Facebook page *
****UUCM will list all registered children, youth and families in the directory
Required
Parent/Guardian Name(s) *
Your answer
NEXT STEP: Fill out Parent/Guardian Registration Form *
***This step is necessary to avoid you having to duplicate parent/guardian information on each child's form. ****Please only fill out ONE Parent/Guardian Registration form PER family.
Required
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