2019 - 2020 First Universalist Church Children & Youth Program Registration Form

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Email *

Name of Child or Youth *

Birthday of Child or Youth *

YYYY

School Grade of Child or Youth *

Primary Address of Child or Youth

Name of Parent(s) or Guardian(s) *

Phone Number of Parent(s) or Guardian(s) *

Please list any allergies (dietary, environmental, etc.) that your child has that we should be aware of:

Please check off any dietary requirements for your child:

Vegan

Vegetarian

Kosher

Halal

Gluten-Free

Dairy-Free

Nut or Tree Nut-Free

Diabetic

Other:

Please list any accommodations that we can make that would be helpful for your child to fully participate in programs at First Universalist:

I, being the legal parent or guardian of the child named above, do hereby grant my permission to the First Universalist Church of Yarmouth for said child to participate in the Faith Exploration Program and related trips during the 2019 - 2020 church year. I, my heirs, and assignees, do hereby release and discharge the First Universalist Church of Yarmouth from any liability or claim or cause of action that I may now have or may have in the future as a result of any injuries received by said child while they participate in the Faith Exploration Program. *

Yes

I authorize the First Universalist Church of Yarmouth to use photos that my child appears in for its website and/or church related publicity. I also understand that the church will only use group photos of children and never identify children by name. *

Yes

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