Religious Education Registration

Parent/Guardian Information
1. Parent/Guardian *

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

CityState / Province

Postal / Zip Code
2. Parent/Guardian

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
3. Emergency Contact*

First NameLast Name
Phone Number*

Area CodePhone Number
Children/Youth
1. Attendee #1 (Full Name)*

First NameLast Name
Birth Date*

MonthDayYear
Date
Grade Level*
Preferred Pronouns*
Allergies?*
2. Attendee #2 (Full Name)

First NameLast Name
Birth Date

MonthDayYear
Date
Grade Level
Preferred Pronouns
Allergies?
3. Attendee #3 (Full Name)

First NameLast Name
Birth Date

MonthDayYear
Date
Grade Level
Preferred Pronouns
Allergies?
Registration Type
4. Attendee #4 (Full Name)

First NameLast Name
Birth Date

MonthDayYear
Date
Grade Level
Preferred Pronouns
Allergies?
5. Attendee #5 (Full Name)

First NameLast Name
Birth Date

MonthDayYear
Date
Grade Level
Preferred Pronouns
Allergies?
6. Attendee #6 (Full Name)

First NameLast Name
Birth Date

MonthDayYear
Date
Grade Level
Preferred Pronouns
Allergies?
Special Needs

Special needs note: We include all children in the religious education program. Knowing in advance the needs of your child can help us plan appropriate support.
Please let us know anything important about your child:
Dietary Needs
Medical Information and Consent

The child(ren) listed on this form have my permission to participate in religious education activities at First Unitarian Church of St. Louis. In the event of a medical emergency where I (parent/guardian) am not available, the religious education staff of First Unitarian Church of St louis has permission to treat and/or transport my child for medical attention.
Preferred Hospital*
Doctor's Name*
Doctor's Phone Number
I agree to this release*
Is there anyone who is NOT allowed to pick up your children?
Photo Release/Permission Form

I grant First Unitarian Church of St. Louis permission to use the image of my child(ren) from Religious Education events for the sole purpose of promoting the RE program of the church. This includes using said images on the website, social media, and e-newsletters. I understand that First Unitarian Church of St. Louis takes the utmost care to protect children's identities and that under no circumstances will a child's name be associated with any photographs that appear.
I agree to this photo release*
Covid-19 Safety

As the 2023/2024 academic year approaches the COVID-19 community risk level for the city of St. Louis, MO is low. If the risk level increases precautions may change and this will be communicated through email to all registered participants.
Parental Consent

The child(ren) listed on this form have my permission to participate in religious education activities at First Unitarian Church of St. Louis.
Signature

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Parent/Guardian Information

Children/Youth

Special Needs

Medical Information and Consent

Photo Release/Permission Form