UUCB Religious Education Registration 2019-2020
Please complete ONE form per family.  You will have the opportunity to enter each child/youth within this form.  You should receive a follow up email with information for payment/scholarship information withing 48 hours of registration. Please contact Director of Religious Education,  Adrienne Summerlot dre@uubloomington.org if you have any questions.  THANK YOU!!!
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Child/Youth's Information
First Name *
Last Name *
Preferred Name and Pronouns (to display on nametag)  ie: Susie (she/her/hers)
Date of Birth (xx/xx/xxxx) *
Current School Grade(or home school equivalent) as of August 2019 *
Register Child for (you may select multiple for 1 child/youth if applicable ie: HS youth group and Coming of Age) *
Special Needs (Medical, Dietary, Accessibility, etc)
Photo Release   *
Do you have additional children to register? *
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