2022-23 Religious Education Program Registration

Child's Name

Child's pronouns (they/them, she/her, he/his are some examples)

Child's Date of Birth (please double check year)

Name of School child will be attending in 2022-23

Child's email - Optional. Only provide for those in high school.

Parent/Guardian/Caregiver Information

Parent/Caregiver Name #1

Relationship to Child (parent, foster parent, legal guardian are examples)

This address will receive a confirmation email

Phone

Address

Parent/Caregiver Name #2

This address will receive a confirmation email

Address

Vital Information

Does the child have significant/life threatening allergies?

Yes No

Description of allergy and emergency instructions

Emergency Contact #1

Emergency Contact Relationship to the Child

Emergency Contact Phone

Emergency Contact #2

Emergency Contact Relationship to the Child

Emergency Contact #2 Contact Phone

Permission and Participation

Permission to release medical information: By typing my name below, I give A2U2 staff and/or volunteers permission to release the above information about my child(ren) to medical authorities and to obtain emergency medical treatment when I cannot be reached or when delay would be dangerous to my child/children's health.

Permission to post photographs: By typing my name below, I give A2U2 staff and/or volunteers permission to post photographs of my child(ren) in the church's website, Facebook pages, or in other public venues under the condition that my child(ren) will not be individually identified.Note that we strive to maintain a balance between privacy and sharing important moments with the congregation.

Year-Long Permission to Participate and General Release: By Typing my name below, I indicate that child(ren) listed above has my permission as their parent or legal guardian to participate in any and all events and activities sponsored or endorsed by Allen Ave UU Church during the next 12 months. I acknowledge that by participating in church-sponsored events my child may be involved in activities that occur both on and off church property, including the crossing of streets, and take place during both day and evening hours, occasionally involving overnight stays, requiring transportation by a motorized vehicle, involving preparation and consumption of food and involving the use of tools, chemicals, fire or other materials and objects. I further acknowledge that by participating in church-sponsored events my child may be involved in age-appropriate recreation and sporting activities, including but not limited to hiking, climbing, swimming, skiing, basketball, volleyball, baseball and Frisbee. Accordingly, I acknowledge that participation in such events involves certain inherent dangers and risks, and may expose my child(ren) to hazards of bodily injury or property damage and may result in my child(ren) being unable to contact me or unable to receive immediate medical assistance if injury occurs. In recognition of these risks and realities and in consideration of my child being offered the opportunity to participate in and benefit from these church-sponsored events, I agree on behalf of myself and my child to release, waive and disclaim any and all liabilities of or claims against Allen Avenue Unitarian Universalist Church, its minister(s), officers, board members, supervisors, agents, servants, employees and all private persons or organizations volunteering services without charge to transport, supervise or chaperone my child(ren) while participating in church-sponsored activities, including but not limited to any or all liabilities or claims for personal injury, property damage, court cost, attorney's fees and interests, however caused or accrued, as a result of my child participating in church-sponsored events.

In considering the above activities, which age group would be most fun for you to work with? Infants and Toddlers Preschool and Kindergarten Grades 1-4 Grades 5-8 Grades 9-12 No preference

2022-23 Religious Education Program Registration

Description

Please Fix the Following