RE Registration 2017-18: New Registration Or Updated Information

* 1. Child #1's Information

Name:

Service Time (9:30 or 11:30)

Birthdate

Grade (2017-18)

Allergies

Medications

* 2. Child #2's Information

Name:

Service Time (9:30 or 11:30)

Birthdate

Grade (2017-18)

Allergies

Medications

* 3. Child #3's Information

Name:

Service Time (9:30 or 11:30)

Birthdate

Grade (2017-18)

Allergies

Medications

* 4. Child #4's Information

Name:

Service Time (9:30 or 11:30)

Birthdate

Grade (2017-18)

Allergies

Medications

* 5. Adult #1's Information

Name:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

* 6. Adult #2's Information

Name:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

* 7. PLEASE share any information about your child(ren) or youth that will help us make this the best possible experience for them (special needs, developmental concerns, learning styles, etc.). Or e-mail dre@uucss.org.

* 8. Our RE Program relies on the time and talents of many individuals. We ask that every family with a child or youth registered in our program contribute in one of the following ways (please indicate your preference):

Age Specific RE Class Teacher (2x/month for 6-7 months during the 9:30 service)

Children's Worship Assistant (9x/year during the 9:30 service)

Spring Mini-Course Teacher; topic of your choice! (5x in the spring)

Art Assembly Assistant (3x/year, usually on holiday weekends)

Nursery Substitute (as needed)

Substitute Teacher (as needed)

Children and Youth RE Committee Member (evening meetings 1x/month)

I cannot volunteer at this time

* 9. VACCINATION POLICY—UUCSS policy requires that all children and youth be vaccinated according to the Centers for Disease Control and Prevention recommended schedule. By typing my full name in the space provided, I am verifying my compliance with this policy and agreement to remain in compliance while attending UUCSS or that my child has a medical exemption preventing compliance with this policy.

If your child has a medical exemption please indicate the exemption below.

Parent/Guardian Name:

Date:

Medical Exemption:

* 10. PHOTO RELEASE FORM—By typing my full name in the space provided, I grant UUCSS permission to use photos or videos of my child(ren) on the UUCSS website and/or in UUCSS brochures or on bulletin boards at church.

Parent/Guardian Name:

Date: