Unitarian Universalist Church of Cheyenne Program Registration
Faith Development Program Registration
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Registrant's information
Please complete a new form for each person registering.
Registrants First Name *
Registrant's Last Name *
Grade/age as of September 2019 *
Date of Birth *
Identifying Gender
Preferred Pronouns
With whom does the child/youth live? Is there a family situation that might be of concern/helpful for you/your child that our Faith Development Team should be aware of?  Please be very specific with any extra needs you or your child may have. Having a good sense of who our students are helps us plan better for classes and staffing.
Special learning needs that you/your child may have? (like difficulties with reading, writing or processing information) If none please indicate NA.
If a child, is the child is on medication (and if that medication is discontinued on the weekend)• Any other medical conditions we should be aware of? If none indicate NA. *
Allergies we need to be aware of? ex: "allergic to nuts" or "gluten intolerant" or "ADHD diagnosis" if none write "NA" *
Primary Contact (parent/guardian full names if registrant is a child. Otherwise please enter registrants information in this space) *
Primary contact's relationship to the registrant *
Primary contact's preferred phone *
Primary contact's preferred email address *
Mailing Address *
Second parent/guardian's full name (or emergency contact if registrant is an adult) *
Secondary contact's relationship to the registrant *
Secondary contact's preferred phone *
Signature: By typing my name below as an electronic signature, I recognize that UUCC is a peanut-free building and I will not bring in/send in any peanut products. *
Signature: By typing my name below as an electronic signature, I recognize that UUCC - Faith Development Programs are an electronic free zone. We ask that youth leave all phones, games, or other electronics in their bag, jacket or backpack. UUCC is not responsible for lost, broken or stolen electronics.
By typing my name below I acknowledge my understanding that all children and youth ages 6 months - 5th grade must be registered into UUCC's Faith Development program AND signed in and out via Kidcheck app when I drop my child/youth off at class. Parent's/Guardians are required to pick children/youth under 6th grade up immediately following the 12:15 release time. Youth 6th grade and older will be able/required to check themselves in and out of class.  Youth over 6th grade will be released at the close of class and are expected to locate their group upstairs prior to moving on to additional activities. If a problem arises during Faith Development or Nursery times a parent/guardian will either personally be located OR texted through either the Kidcheck app or by cell phone. In an emergency texts will be sent out through cell phones and/or an announcement will be made in all locations. *
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