ASUU-RE Online Registration Form

All Souls Unitarian Universalist Congregation
23 Jay Street, New London, CT 06320
Phone ~ 860-443-0316 · Email ~ info@allsoulsnewlondon.org

CHILDREN & YOUTH 2011-2012 RELIGIOUS EDUCATION REGISTRATION

Please complete one form per child.

1. Child's Name

2. Age and Date of Birth

3. Grade in school

4. Please list any special needs such as medications, life threatening allergies, and pertinent information you feel the RE program needs in order to provide your child with the best possible learning environment. IF none, please indicate "None".

5. Parent/Guardian Name

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone-home

Area CodePhone Number

Phone-cell

Area CodePhone Number

6. Parent / Guardian Involvement

(a) I/we would like to teach, and prefer the following grade group (check at least one):

(b) I/we would like to volunteer as a Nursery Assistant:

(c) I/we would like to be a Member of a Religious Education Leadership Circle:

(d) I/we would like to help with the 2012 Summer program

7. I am/We are Pledging Member(s)/Friend(s) (RE fee waived for pledging Members and Friends)

8. A $50 fee is included with this registration ($50 each additional child - $100 per family maximum)

9. Please contact Nathan Pawelek, Director of Religious Education, at (860) 443-0316, or dre@allsoulsnewlondon.org for information on financial waiver or if you are interested in becoming a pledging member.

10. Remit signed Registration form(s) and $50 fees, if required, per registered child, checks payable to All Souls UU Congregation, to: ASUUC - RE, 19 Jay Street, New London, CT 06320

Religious Education Registration/Enrollment

By registering my child(ren), I recognize and accept the responsibility to help.

It is understood that each family will volunteer in some way each year, and will teach at least every other year.

I grant permission for my child(ren) to take part in the Religious Education ministry at All Souls UUC-New London, including supervised excursions away from the church.

Submitting this online form indicates your agreement to all the conditions above to which you responded. The date of the electronic submission of this form is the date of your registration.

REMEMBER TO ALSO SIGN THE CONSENT FORM BELOW
and
CLICK THE "SUBMIT" BUTTON AT END WHEN YOU ARE FINISHED.

PLEASE DOUBLE-CHECK YOUR RESPONSES.

ALL SOULS UNITARIAN UNIVERSALIST CONGREGATION

PARENT / GUARDIAN CONSENT FORM

FOR PHOTOGRAPHS AND VIDEOS

1. I give All Souls UU Congregation permission to photograph and/or video my child(ren). I further give All Souls UU Congregation permission to use photographs or videos of my child(ren) on the All Souls website, newsletter, and/or the All Souls Facebook page. I understand that no names will be associated with photos or videos of children and youth. I also release from any liability All Souls UU Congregation, its employees and/or volunteers in relation to the taking and/or displaying of any photographs/videos.

I have read and agree to the terms and conditions stated above.

Name(s) of Child(ren)

Printed name of Parent/Guardian

2. I do not give permission to All Souls UU Congregation to use photographs or videos of my child(ren) with the exception of photographs of large groups in the congregation in which they may appear.

Name(s) of Child(ren)

Printed name of Parent/Guardian

Submitting this online form indicates your agreement to all the conditions above to which you responded. The date of the electronic submission of this form is the date of your registration.

CLICK THE "SUBMIT" BUTTON AT END WHEN YOU ARE FINISHED.

PLEASE DOUBLE-CHECK YOUR RESPONSES.

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