First Congregational UCC Children 2025-26 Information and Consent Form

First Congregational UCC Children 2025-26 Information and Consent Form

You will complete a separate page for each child. You can skip past the duplicate pages if/when needed. This is only for kids ages birth through 5th grade. Youth will use a different form.
Child one
Child's name*

First NameLast Name
Child's pronouns*
Date of Birth*

MonthDayYear
Date
School*
Grade Level*
Please use the space below to tell us about any allergies, medical conditions, or concerns or requests you might have about your child.*

Child two (if applicable)
Child's name

First NameLast Name
Child's pronouns
Date of Birth

MonthDayYear
Date
School
Grade Level
Please use the space below to tell us about any allergies, medical conditions, or concerns or requests you might have about your child.

Child three (if applicable)
Child's name

First NameLast Name
Child's pronouns
Date of Birth

MonthDayYear
Date
School
Grade Level
Please use the space below to tell us about any allergies, medical conditions, or concerns or requests you might have about your child.

Child four (if applicable)
Child's name

First NameLast Name
Child's pronouns
Date of Birth

MonthDayYear
Date
School
Grade Level
Please use the space below to tell us about any allergies, medical conditions, or concerns or requests you might have about your child.

Parent/Guardian Information

If you do not wish for a parent to be included in communication due to them not attending FCUCC, please do not include their information below.
Adult 1 Name*

First NameLast Name
Adult 1 Relationship*
Adult 1 Email*
example@example.com
Adult 1 Phone Number*
Please enter a valid phone number.
Adult 2 Name

First NameLast Name
Adult 2 Relationship
Adult 2 Email
example@example.com
Adult 2 Phone Number
Please enter a valid phone number.

Media Consent and General Acknowledgement
I give consent to First Congregational UCC to use pictures/videos of my child(ren) for church advertisements in all capacities and on all social media platforms, including www.uccmanhattan.org.

Please check box to consent, leave box unchecked if you don't consent.
I give consent to First Congregational UCC to use pictures/videos of my child(ren) in the private Facebook group named "First Congregational UCC Members and Friends" ONLY.

Please check box to consent, leave box unchecked if you don't consent. If consenting to above picture/video release, please choose "consent already given above".
Parent/Guardian Signature*

Clear
Date Signed*

MonthDayYear
Date

All volunteers and staff go through twice yearly training on emergency procedures including severe weather, fire, and active shooter. It is the policy of the church that there always be at least one volunteer or staff member present who is trained in First Aid and CPR. We also train all volunteers and staff on Safe Conduct procedures to ensure all children and youth are protected. Should you ever want to know more about these procedures or training, please don't hesitate to reach out to Brandy or Pastor Caela.
Check box to acknowledge understanding of Safe Conduct and Emergency procedures in place.
Should be Empty:

Child one