Registration for UUCC's Religious Education Program
Please fill out this form and click submit.
Parent/Guardian Information
Name of Parent/Guardian#1
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Parent/Guardian #2 (if applicable)
Email
Phone
Address (if different)
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Child Information
Complete information for each child who will be participating in our program, including those in our nursery care.
Name of Child #1
*
Birthdate of Child #1
*
Grade in School of Child #1
*
List allergies and medical issues (if any) of Child #1
Name of Child #2
Birthdate of Child #2
Grade in School of Child #2
List allergies and medical issues (if any) of Child #2
Name of Child #3
Birthdate of Child #3
Grade in School of Child #3
List allergies and medical issues (if any) of Child #3
Name of Child #4
Birthdate of Child #4
Grade in School of Child #4
Allergies and medical issues (if any) of Child #4
Name of Child #5
Birthdate of Child #5
Grade in School of Child #5
Allergies and medical issues (if any) of Child #5
Please let us know about any accessibility needs your child(ren) may have or any other information that would be helpful for supporting them in our R.E. program:
Photography/Video Permission
Do you consent for photos/videos of your child to be used:
*
Please select all that apply.
For display in the church?
In our church newsletter?
On our church website?
In our private church Facebook groups?
Submit
Description
Please fill out this form and click submit.
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