Side Door Online Registration 2018-2019
This form must be completed in order for your child to attend Side Door.
Youth's last name *
Your answer
Youth's first name *
Your answer
Sex *
School *
Please write the name of the school if you choose "other"
Grade *
Student email address?
(to receive Side Door updates)
Your answer
Student cell phone?
(to receive emergency schedule changes)
Your answer
Home phone *
If you do not have a land line, please enter your cell phone number
Your answer
Street address *
street address for program mailings etc. (you don't need to enter town or state)
Your answer
Apartment number?
Your answer
Town *
Your answer
Zipcode *
Parents' names *
Your answer
Parents' contact information - how to reach you (home/cell/ work phones) on Friday afternoons *
Your answer
Parent email *
(for program communications)
Your answer
Is there anything about your child we should know? Allergies? Medications? Medical conditions?
Your answer
Emergency contact (name and phone numbers) *
Your answer
Do you give permission for Side Door staff and volunteers to seek medical attention - including but not limited to hospitalization in an emergency when you cannot be reached? *
Required
Do you give permission for photos of your child to be used in Side Door newsletters and publicity (online and print)? (No names will be used.) *
Required
Please consider making a donation to the program. You can donate soda or snacks, bottled water, snacks etc for one of our celebrations, or you can mail in a check, drop off a donation, or make a donation on our website. *
I understand that my child must leave Side Door by 5:15 pm, and that if I am unable to arrange for pick up my child I will make arrangements to meet my child elsewhere. *
Please check box to indicate that you understand that your child must be off UCC property after 5:15 pm.
Required
My signature below indicates that my child has my permission to attend Side Door at Union Congregational Church. *
Please sign by entering your name in the space below.
Your answer
PLEASE NOTE! When your child attends Side Door for the first time, s/he will be asked to agree to the following behavior contract in order to complete this registration.
While at Side Door I promise:
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