Children & Youth Religious Education Program Registration
This form is for registering your child for Cedar's Religious Education classes. Please fill in a separate form for each child.
Child/Youth Information
Name of Child
*
Gender
*
Date of Birth
*
School
Grade
Please select one option.
Infant
Toddler
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Email (youth only)
Additional information for the teachers (disabilities, dietary needs/allergies, etc.)
Parent Information
Name of parent/guardian filling out this form
*
Is this parent the emergency contact?
*
Please select one option.
Yes
No
Select Option
Yes
No
Are you interested in assisting with...
Please select all that apply.
teaching an RE class
assisting another teacher in an RE class
program preparation
driving for field trips
Name of other parent/guardian who should also receive RE communications
Is this parent also an emergency contact?
*
Please select one option.
Yes
No
Select Option
Yes
No
Permissions
Photos of my children may be used in brochures/website/promotional materials/Facebook Group page. (names will not be used)
*
Please select one option.
Yes
No
Select Option
Yes
No
My child may go off the church property/ride in a car with RE volunteers or staff for scheduled/pre-planned field trips/activities and within walking distance during RE lessons.
*
Please select one option.
Yes
No
Select Option
Yes
No
My youth (grades 6-12) may view a PG-13 or R rated movie if it has been evaluated by the Director and is in alignment with a social justice topic being covered in the class programming. (no movies with intense violence, blood, gore or sexual content will be shown)
*
Please select one option.
Yes
No
Contact me first
Select Option
Yes
No
Contact me first
Liability Limitations: I acknowledge although CUUC has taken safety measures to minimize risk of injury to RE participants, CUUC cannot insure nor guarantee that participants equipment, premises and/or activities will be free of hazards, accidents and/or injuries. I further recognize and will instruct my child/youth in the importance of knowing and abiding by church/school rules, regulations and procedures for the safety of the community.
*
Please select one option.
Agree
Do No Agree
Select Option
Agree
Do No Agree
Emergency Consent for Care: I give permission for any emergency medical, surgical, diagnostic and hospital care, treatment and procedures to be performed by a licensed Physician or hospital when deemed immediately necessary or advisable by a physician to safeguard my child's/youth's health when I cannot be contacted. I agree to be responsible for any expenses not covered by my insurance, which may be incurred as a result of an accident or medical emergency involving my child/youth.
*
Please select one option.
Agree
Do Not Agree
Select Option
Agree
Do Not Agree
Submit
Description
This form is for registering your child for Cedar's Religious Education classes. Please fill in a separate form for each child.
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