Registration Form for the 2021-2022 year for 6th & 7th Grade Middle School at UUCC

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Please use this registration form to register for the 6th and 7th grade class for the 2021-2022 church year.

Parent/Guardian Name(s) *

Mailing Address (street, city, state, zipcode) *

Parent Phone number *

Parent Email Address *

Student Name *

Student date of birth *

YYYY

Student Grade *

6th grade

7th grade

We will likely need to schedule a multi-platform class of middle school students, due to the number of students and covid restrictions. Please respond to the next question for each option with Prefer, Willing, or Not Possible.

My child will attend: *

Prefer

Willing

Not Possible

Sundays, 5:00-6:30 pm

Sundays, 12:00-1:30 pm

Weekday, by consensus, 5:00-6:30

Virtual only class until after vaccination

Taking turns for in-person and virtual class

We have not yet been able to recruit teachers for the middle school class. Are you willing to be a teacher or assistant for this class?

I am willing to help by: *

Teaching

Assisting

Not able to help this year

Sunday 12:00-1:30 pm class

Sunday 5:00-6:30 pm class

Wednesday 5:00-6:30 pm class

Thursday 5:00-6:30 pm class

Student Allergies/Medications

How can we best help your student succeed in class?

Photo Consent

We occasionally take photos of children during UUCC religious education classes and or worship services for use online and in publicly printed materials. Please indicate permission to take your child(ren)'s picture.

Photo Consent *

I give consent for my child to have pictures taken

I do not give consent for my child to have pictures taken

Required

Release of Liability

I understand that it is my responsibility to pick up my child(ren) promptly at dismissal time, or to delegate another member of the congregation to do so. I understand that I am responsible for the supervision of my child(ren) at UUCC at all times outside of RE class time. I release UUCC from any and all liability.

Electronic Signature

Submit

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