RE Registration Form

Fields marked with an * are required

1. Parent/Guardian and Emergency Contact Information

2. Please register your child(ren)/youth.

1st Child/Youth

2nd Child/Youth

3rd Child/Youth

4th Child/Youth

3. Please choose the RE program you wish to enroll your child(ren)/youth.

4. Individual Needs

We would like to do our best to meet your child(ren)’s needs. Please indicate here if there is ANY thing that we can do to accommodate your child(ren). This could mean helping us to work with your child(ren)'s learning differences, emotional needs, physical needs, or allergies. We want your child(ren) to feel comfortable and welcome in the RE classroom.

5. Please share with us any medications taken by or known allergies of your child(ren)/youth.

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

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

8. I give permission for my child(ren)'s photo to be published in local newspapers and on our church website or Facebook page.

9. Youth Participation Release & Authorization for Emergency Medical Treatment

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 Universalist Church of Canton 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 son(s) and/or daughter(s) to the person or property of others. Should any injury occur, I grant permission for my son(s) and/or daughter(s) 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 Universalist Church of Canton and /or any and all adult supervisor may incur as a result of securing such treatment.

10. Emergency Medical Contact Information