2022-2023 UUCSR RE Registration Form
Register your children and youth for RE! In order to participate in RE events and to ensure your child is being well and safely cared for, please fill out the following registration form. If you have any needs or concerns in regards to your child's attendance, please contact Director of Religious Education Era Capone at DRE@UUSantaRosa.org
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Parent/Guardian #1 Name *
Parent/Guardian #1 Phone Number (mobile number preferred) *
Parent/Guardian #1 Email *
Parent/Guardian #2 Name
Parent/Guardian #2 Phone Number (mobile number preferred)
Parent/Guardian #2 Email
Child #1 Name *
Child #1 Pronouns *
Child #1 Date of Birth *
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Child #1 Grade in September 2022 *
Child #1's Allergies
Child #1's Special Needs
Child #2 Name
Child #2 Pronouns
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Child #2 Date of Birth
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DD
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YYYY
Child #2 Grade in September 2022
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Child #2's Allergies
Child #2's Special Needs
Child #3 Name
Child #3 Pronouns
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Child #3 Date of Birth
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DD
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YYYY
Child #3 Grade in September 2022
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Child #3's Allergies
Child #3's Special Needs
Child #4 Name
Child #4 Pronouns
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Child #4 Date of Birth
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DD
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YYYY
Child #4 Grade in September 2022
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Child #4's Allergies
Child #4's Special Needs
Alternate Emergency Contact #1 Name *
Alternate Emergency Contact #1 Phone Number
Alternate Emergency Contact #2 Name
Alternate Emergency Contact #2 Phone Number
Child's Physician
Physician's Phone Number
Health Insurance Provider
Photography/Video Permission and Publication (check any or all boxes to give consent)
Please select one or more options from the following about where you would be able to volunteer. We ask that parents and guardians be willing to volunteer at least once a month during Sunday RE in one or more of the following roles: *
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