2023-2024 UCS RE Registration Form

Parent or Guardian Name

This address will receive a confirmation email

Home Phone

Mobile Phone

Address

Parent/Guardian Email for RE communications if different from above

Parent #2 (if applicable)

Name

Phone number

Child/Youth Registration

1st Child/Youth

Name

Date of Birth

Grade as of September 2023

Youth email for RE class commuications

Youth Phone (if applicable)

Individual Needs for 1st Child/Youth - Please indicate here if there is ANY thing that we can do to accommodate your child/youth. This could mean helping us to work with your child/youth's learning differences, emotional needs, physical needs, or allergies. We want your child/youth to feel comfortable and welcome in the RE program.

Medications and Allergies of 1st Child/Youth - Please share with us any medications taken by or known allergies of your child/youth.

2nd Child/Youth

Name

Date of Birth

Grade as of September 2023

Youth email for RE class communications

Youth phone

Individual Needs for 2nd Child/Youth - Please indicate here if there is ANY thing that we can do to accommodate your child/youth. This could mean helping us to work with your child/youth's learning differences, emotional needs, physical needs, or allergies. We want your child/youth to feel comfortable and welcome in the RE program.

Medications and Allergies of 2nd Child/Youth - Please share with us any medications taken by or known allergies of your child/youth.

3rd Child/Youth

Name

Birthdate

Grade as of September 2023

Youth email for class communications

Youth phone number

Individual Needs for 3rd Child/Youth - Please indicate here if there is ANY thing that we can do to accommodate your child/youth. This could mean helping us to work with your child/youth's learning differences, emotional needs, physical needs, or allergies. We want your child/youth to feel comfortable and welcome in the RE program.

Medications and Allergies of 3rd Child/Youth - Please share with us any medications taken by or known allergies of your child/youth.

4th Child/Youth

Name

Birthdate

Grade as of September 2023

Youth email for class communications

Youth phone number

Individual Needs for 4th Child/Youth - Please indicate here if there is ANY thing that we can do to accommodate your child/youth. This could mean helping us to work with your child/youth's learning differences, emotional needs, physical needs, or allergies. We want your child/youth to feel comfortable and welcome in the RE program.

Medications and Allergies of 4th Child/Youth - Please share with us any medications taken by or known allergies of your child/youth.

Permissions

Would you like to have a one-on-one discussion about your child(ren)'s needs with the Director of Religious Education?

Yes No

I authorize the RE staff to share relevant information regarding the special needs of my child(ren) with RE teachers.

Yes No

I give permission for my child(ren)'s photo to be published in local newspapers and on our church website or Facebook page. (No names will be posted)

Yes No

Child/Youth Participation Release and Emergency Medical Treatment Authorization

I grant permission for my child(ren) to participate in adult-supervised Religious Education activities and field trips. I grant permission for my child(ren) to be transported to and from the location by reasonable and safe means. I agree and hereby do release and hold harmless the Unitarian Church of Sharon and/or all adult supervisors for the activity, from and for any and all liability which may arise for damages, loss, or injuries, either to person or property, which my child(ren) may sustain while engaged in the activity conducted, including, but not limited to, any damages, loss or injuries that may be sustained through transportation to and from the activity. I further agree to assume responsibility for any liability which may arise for damages, loss, or injuries, as described herein which may be caused or contributed to by my child(ren) to the person or property of others. Should any injury occur, I grant permission for my child(ren) to receive treatment from an appropriate health care provider to be selected by the adult supervisor of the activity, when, in such supervisor’s opinion, the need for such treatment is immediate, and when efforts to contact me (us) are unsuccessful. I also agree to pay and be responsible for all medical, hospital or other expenses which the Unitarian Church of Sharon and /or any and all adult supervisor may incur as a result of securing such treatment.

Yes No

Emergency Medical Contact Information

Family Physician's Name

Physician's phone

Insurance provider

Insurance ID#

Subscriber

Payment

If you prefer to pay your RE fees by Check, select that payment option below and mail your check or drop it off at the Admin office.

RE Program fee

How will you help?

Religious education at the Unitarian Church of Sharon is a cooperative effort. It takes a village! We work to ensure that no volunteer takes on more than they would like and can still participate in the life of the church on Sundays and beyond. Please indicate your ability to help below and the DRE will contact you to discuss. Program descriptions here.

When I can help Fall Winter Spring

Please remember to submit this form when complete.

You should expect to receive an email with the Subject: UCS RE Registration Form Confirmation.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2023-2024 UCS RE Registration Form

Description

Please Fix the Following