Religious Education Registration Form
2016 - 2017
Copyright ©   2015 The Unitarian Universalist Church in Meriden, CT -  All Rights Reserverd                                                                  Privacy Policy       Site Map

Follow us on Twitter
Like us on Facebook
In order to prevent automated systems from submitting this form, please fill in the 5 random characters in the box provided before pressing the submit button.  The characters are case-sensitive.
(NOTE: If you are having trouble reading the characters, click on them to generate a fresh set.)
HINT:  The letters
must be

ALL CAPITALS
LAST name of child
FIRST name of child
Date of Birth
Grade (as of Sept 2015)
1
2
3
4
Medical Care Authorization: Should my minor youth require emergency medical treatment as a result of an accident or illness arising during a field trip or regular youth meeting or class, I consent to such treatment. I acknowledge that the Unitarian Universalist Church in Meriden does not provide health and accident insurance for class or field trip participants and I agree to be financially responsible for any medical bills incurred as a result of emergency medical treatment. I have completed a Medical Information Form for each child registered in the CYRE program.
5
Parent / Guardian #1
Address
Apartment
Zip
City
Telephone (with Area Code)
Home
Work
Mobile
Email Address
Parent / Guardian #2
Address
Apartment
Telephone (with Area Code)
Home
Work
Email Address
Zip
Mobile
Children Live With
Both
Parent / Guardian 1
Parent / Guardian 2
List any allergies for each child:
Click for new image
Are there any personal concerns you wish to share:
Disclosure: I understand that an adult supervisor will accompany my child/youth on all activities. I also understand that the supervisors are volunteers and not trained professionals. I acknowledge that there are certain risks inherent in field trips/class and that all risks cannot be prevented. I represent that my minor child is physically able, with or without accommodation, to participate in this class or field trip and is able to use the equipment and/or supplies necessary. I understand that the church does not accept responsibility for any bodily injury incurred during this year. (Sept 2016-June 2017 regular class year and/or Summer 2017)
Parent/Guardian’s Responsibility: I will make certain that my child/youth is properly prepared for all activities, including having the proper clothes and equipment, and will inform the supervisor in writing of any physical, emotional, social or other concern of which the supervisor should be aware.
Name of Parent or Guardian Submitting form:
By submitting this form I hereby state that I am the legal parent or guardian of the above child / children, have submitted all of the information required above, and accept the conditions listed on this form.
In order for your child or children to participate in our Religious Education Programs, including Youth Group, please fill out the registration form below.  If you wish you can download a paper copy of the form and return via mail or in person on Sunday morning to the Director of Religious Education.
I have read and agree to the Behavior Policy for the Children and Youth religious education program at UUMeriden