RE Registration Form Buckman Bridge Unitarian Universalist Church(BBUUC)
Registration is required for every infant, child, and youth participating in religious education programming at BBUUC. Please register even if your infant does not yet go to the nursery or you are unsure how regularly you will attend. We ask you to fill out a registration form each year to help us keep current on medical information, allergies, and important milestones in your child's life.
Email *
Child's First Name *
Childs Last Name *
Date of Birth *
MM
/
DD
/
YYYY
Grade level: *
PreK- 2nd
3rd-5th
6th-8th
9th-12th
Row 1
Preferred Name
Pronouns *
Registration for (please pick one) *
Custodial Situation: Are there any custodial issues we should be aware of, or anyone NOT allowed to pick up the child?
Please list all allergies. (If none please type none) *
What will help your child best engage in our program this year?
Please tell us what you can about any challenges your child has in a group settings, educational settings, or in social settings. We want to best meet their needs so they feel a sense of safety, belonging, and engagement.
Health/ Accident Insurance *
Policy Number *
Emergency Contact Name *
Emergency Contact Phone Number *
Primary/ Guardian Parent First Name ( will receive emails/ messages about the RE program) *
Primary Parent/ Guardian Last Name *
Email *
Phone Number *
Address Line 1
 Address Line 2
Second Parent/ Guardian/ Caregiver First Name
Second Parent/ Guardian/ Caregiver Last Name
Email
Phone
Address Line 1
Address Line 2
Third Parent First Name
Third Parent/ Guardian/ Caregiver
Email
Phone
Address Line 1
Address Line 2
Our program is cooperative between volunteer teachers and families. This means we need the help of every parent/guardian to make our program a success. All parents can expect to be asked to give a gift of self to assist the RE program. Please indicate any interest you have beyond those expected contributions. *
Required
There will be times in RE when we will host guest speakers/workshop facilitators from within the congregation to share about their interests, skills, careers, or committee work here in the church. Please list any special talents or skills, you would be willing and able to share with our children and youth. *
Photography Release:
I/we grant permission to Buckman Bridge Unitarian Universalist Church to take photographs and/or videos of my child during Church-sponsored activities. I/we authorize the BBUUC to use the likeness of my child with or with using the child's name, in print or electronically, for lawful and reasonable purposes including building displays, congregational communications, teacher training, Church promotion, and the website.
Please select yes to grant the above photo release *
Medical & Liability Release
I/we register my child for Religious Education at Buckman Bridge Unitarian Universalist Church understanding that it is a collaborative program between parents, teachers, and the Fellowship community, designed to foster growth and learning in the Unitarian Universalist faith. I/ we authorize the Fellowship and its representatives to render emergency medical assistance and authorize medical and paramedical personnel to do the same. I also understand that although the Fellowship has adopted policies that it believes to be reasonable to protect children, injuries may still occur. I release the Fellowship and all its representatives from any and all claims and liability for any injury to any child of mine, and I agree to indemnify and hold the Church and all its representatives harmless against such claims and liability.
Please confirm you understand and agree to the above statement. *
Date the form was filled out *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of BBUUC. Report Abuse
Google Forms