2018-2019 RE Registration (Children and Youth)
(One form per individual child/youth/ please)
CHILD/YOUTH INFORMATION
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SPECIFIC CLASSES FOR CHILDREN AND YOUTH
Children and Youth are placed in classroom groupings based on age, readiness, and comfort level. Our priority is your young person's comfort. General class groupings are as follows: Chalice Children (about 4-7), Roots and Shoots (about age 8-11), O.W.L. and Junior Youth (about age 12-14), Senior Youth ( high school age)
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
PARENT / GUARDIAN INFORMATION
Name
First Name
Last Name
Best Phone to Reach You
-
Area Code
Phone Number
Best Email to Reach You
example@example.com
Name(s) of any other Adult(s) Authorized to sign out your child
First Name
Last Name
First Name
Last Name
First Name
Last Name
Allergies (including latex), conditions, etc. Anything you want us to know about your child/youth.
WAYS TO HELP
Would you be willing to help in the classroom?
YES! I'd like to help out as a teacher. (Only once per month)
YES! I'd like to assist in the classroom. (Only 1-2 times in the year)
YES! I'd like to help with a classroom event such as the end of year party.
No, I prefer not to participate.
PHOTO AUTHORIZATION
Pictures may be used for publicity purposes such as brochures, bulletin boards, social media, and church website (minors will not be identified by name without parent/guardian permission.)
Do you give permission for your child/youth to be photographed?
YES. You are authorized to photograph the child/youth and/or use their image
NO. Please do not photograph the child/youth or use their image
MEMBERSHIP
Would you like information about Membership at Mill Creek?
YES! Please send me further information about becoming a member of Mill Creek
NO. Do not send information
ROOTS AND SHOOTS CLASS SIGN OUT
For parents/guardians of children in the Roots and Shoots class.
Do you want your child to be signed out every Sunday by their authorized adult.
YES. My child should remain in the classroom until they are signed out.
Not Necessary. My Child has permission to leave the classroom without a sign-out
PARENT /GUARDIAN PERMISSION
My Child/Youth has permission to participate in the 2018-2019 Religious Exploration program at the Unitarian Universalist Society of Mill Creek.
Signature
Submit
Should be Empty: