FE Registration Template

Health and Safety

Please stay home if you aren't feeling well.

Masks are welcome but not mandatory.

Please e-mail safety@jeffersonunitarian.org if your child tests positve for COVID.

If your child or youth is showing symptoms of illness, please do not come to church.
Please confirm that you have read and agree to JUC's health and safety guidelines

YesNo

12_Unique ID Youth 1
13_Youth 1

First NameLast Name
14_Youth 1 Personal Pronouns
15_Youth 1 Birthday

MonthDayYear
Date
16_Youth Grade level on Sept 1, 2022
17_What class do you intend your youth to be a part of?
18_Youth 1 Hobbies or Interests?
19_Youth 1 - Allergies
20_Please share any other information that would support your youth's faith exploration experience (ex. behavioral health needs, environmental sensitivities, additional classroom supports needed, etc).
I have another youth to register

YesNo

21_Unique ID Youth 2
22_Youth 2

First NameLast Name
23_Youth 2 Personal Pronouns
24_Youth 2 Birthday

MonthDayYear
Date
25_Youth Grade level on Sept 1, 2022
What class do you intend this youth to be a part of?
26_Youth Hobbies or Interests?
27_Youth 1 - Allergies
28_Please share any other information that would support your youth's faith exploration experience (ex. behavioral health needs, environmental sensitivities, additional classroom supports needed, etc).
I have another youth to register

YesNo

29_Unique ID Youth 3
30_Youth 3

First NameLast Name
31_Youth 3 Personal Pronouns
32_Youth 3 Birthday

MonthDayYear
Date
33_Youth Grade level on Sept 1, 2022
What class do you intend this youth to be a part of?
34_Youth 3 Hobbies or Interests?
35_Youth 3 - Allergies
36_Please share any other information that would support your youth's faith exploration experience (ex. behavioral health needs, environmental sensitivities, additional classroom supports needed, etc).
I have another youth to register

YesNo

37_Unique ID Youth 4
38_Youth 4

First NameLast Name
39_Youth 4 Personal Pronouns
40_Youth 4 Birthday

MonthDayYear
Date
41_Youth Grade level on Sept 1, 2022
What class do you intend this youth to be a part of?
42_Youth 4 Hobbies or Interests?
43_Youth 4 - Allergies
44_Please share any other information that would support your youth's faith exploration experience (ex. behavioral health needs, environmental sensitivities, additional classroom supports needed, etc).
I have another youth to register

YesNo

Unique ID Youth 5
Youth 5

First NameLast Name
Youth 5 Personal Pronouns
Youth 5 Birthday

MonthDayYear
Date
Youth Grade level on Sept 1, 2022
What class do you intend this youth to be a part of?
Youth 5 Hobbies or Interests?
Youth 5 - Allergies
Please share any other information that would support your youth's faith exploration experience (ex. behavioral health needs, environmental sensitivities, additional classroom supports needed, etc).
I have another youth to register

YesNo

Media Release for 22-23

I do hereby give permission for the above-named minor child (hereinafter "Minor") to be photographed and/or video recorded by Jefferson Unitarian Church (JUC) staff or its representatives.

I understand and agree JUC may use the photographs and/or video recordings containing the words, image, and/or voice of the Minor may be used in the recorded worship service or special church communications or functions ( i.e., annual auction) at Jefferson Unitarian Church and may display such materials publicly. JUC will not use children's names in any images or recordings to protect your family and child's privacy unless separate written permission is given. This permission is for a limited duration of 1 year from the date of this permission form.

Parent, guardian, or legal representative of the above-named Minor can revoke release at any time by contacting Sarah Billerbeck, Director of Faith Exploration, at sarahbillerbeck@jeffersonunitarian.org.
Please confirm that you give permission for JUC to take pictures or videos of your family

YesNoOther
If you selected "Other" above, please share more information about your wishes
Should be Empty:

FE Registration Template - Data Upload