First Unitarian Society of Ithaca Religious Exploration Registration
This form is to be used for all of our Children's Religious Exploration. Please contact Susanne Quagliata with any questions you might have. Fields marked with an * are required
Email address *
Parent/Guardian Contact Information
Parent/Guardian 1
Parent/Guardian 1 First Name *
Your answer
Parent/Guardian 1 Last Name *
Your answer
Parent/Guardian 1 Email *
Your answer
Parent/Guardian 1 Cell Phone *
Your answer
Parent/Guardian 2
Parent/Guardian 2 First Name
Your answer
Parent/Guardian 2 Last Name
Your answer
Parent/Guardian 2 Email
Your answer
Parent/Guardian 2 Cell Phone
Your answer
Home Address / Phone
Address (Street, City, State Zip Code) *
Your answer
Home Phone number
Your answer
Please register your child(ren)/youth
1st Child/Youth
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade as of September 2019 *
Individual Needs for 1st Child/Youth - Please indicate here if there is anything that we can do to accommodate your child/youth. This could mean helping us to work with your child/youth's learning differences, emotional needs, physical needs, or allergies. We serve simple snacks most Sundays. Please list foods your child(ren) can’t/shouldn’t eat. We want your child/youth to feel comfortable and welcome in the RE classroom.
Your answer
2nd Child/Youth
First Name
Your answer
Last Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade as of September 2019
Individual Needs for 2nd Child/Youth - Please indicate here if there is anything that we can do to accommodate your child/youth. This could mean helping us to work with your child/youth's learning differences, emotional needs, physical needs, or allergies. We serve simple snacks most Sundays. Please list foods your child(ren) can’t/shouldn’t eat. We want your child/youth to feel comfortable and welcome in the RE classroom.
Your answer
3rd Child/Youth
First Name
Your answer
Last Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade as of September 2019
Individual Needs for 3rd Child/Youth - Please indicate here if there is anything that we can do to accommodate your child/youth. This could mean helping us to work with your child/youth's learning differences, emotional needs, physical needs, or allergies. We serve simple snacks most Sundays. Please list foods your child(ren) can’t/shouldn’t eat. We want your child/youth to feel comfortable and welcome in the RE classroom.
Your answer
4th Child/Youth
First Name
Your answer
Last Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade as of September 2019
Individual Needs for 4th Child/Youth - Please indicate here if there is anything that we can do to accommodate your child/youth. This could mean helping us to work with your child/youth's learning differences, emotional needs, physical needs, or allergies. We serve simple snacks most Sundays. Please list foods your child(ren) can’t/shouldn’t eat. We want your child/youth to feel comfortable and welcome in the RE classroom.
Your answer
Youth Participation Release & Authorization
I grant permission for my child(ren) to participate in adult-supervised Religious Exploration activities. *
I authorize the RE staff to share relevant information regarding the special needs of my child(ren) with RE teachers. *
I grant permission for photos of my child(ren) in religious exploration activities to be published on the church website and social media, church-only emails, or in the church building. I understand there will be no names used. *
Parent Commitment
Our UU Religious Exploration Program is a cooperative endeavor. RE volunteers learn new skills and make lifelong connections to people of all ages. Which activities will you sign on for this year? *
Required
Is there anything else it would be good for us to know?
Your answer
A copy of your responses will be emailed to the address you provided.
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