Registration for Religious Education for Children and Youth

Parent Name 1*
First Last
Parent Name 2
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone Parent 1
Phone Parent 2
Email Parent 1*
Email Parent 2*
Children & Youth Information
Name Birth Date School Grade
Special Needs and Allergies
Please let us know about any health conditions, medications, allergies, or special needs we need to plan for in order to ensure safety. Be sure to specify the name of the person you're describing for us.
Photo Permissions
- Photographs may be taken and published in RRUUC media of my child without prior knowledge
- I do not want photos of my child published
Permission for Participation
- I give permission for my child to participate in the Religious Education program and know that I will be notified of any classes off-site.

Name	Birth Date	School Grade

River Road Unitarian Universalist Congregation