Registrations

Fields marked with a * are required

Household Name:	*
	e.g., Jones or Smith-Jones
Are you new to RE?	No Yes*
Address:	*
	Weekly updates are sent to this address
City:	*
State:	*
Zip:	*
Email:
Child's Physician Name:	*
Physician Phone #	*

Parent #1

First Name:

Last Name:

Home Phone:

Work/Cell Phone:

Same address as household

Address:

City:

State:

Zip:

Email:

Our program is cooperative - we can't do it without you!
You must check at least one item from each section.
Parent #1 is willing to help by

Teach RE class 2x a month (pre K or 5th-7th)

Group Guide 4-5 wk rotation only (K-4th)

Workshop Facilitator 4-5 wk rotation only (K-4th)

Substitute teacher, group guide or workshop facilitator

I am new to RE, or have special circumstances - please contact me

* At least one of the above boxes must be checked

Parent #1 can also help with the following special events

Haunted House

Christmas Pageant

Seder

Easter

Diwali

RE Sunday Cook Out

Art Link

Organizing books/ supplies, helping office staff

Can help on activity days with music, art, storytelling, etc.

Parent #2

First Name:

Last Name:

Home Phone:

Work/Cell Phone:

Same address as household

Address:

City:

State:

Zip:

Email:

Our program is cooperative - we can't do it without you!
You must check at least one item from each section.
Parent #2 is willing to help by

Teach RE class 2x a month (pre K or 5th-7th)

Group Guide 4-5 wk rotation only (K-4th)

Workshop Facilitator 4-5 wk rotation only (K-4th)

Substitute teacher, group guide or workshop facilitator

I am new to RE, or have special circumstances - please contact me

Parent #2 can also help with the following special events

Haunted House

Christmas Pageant

Seder

Easter

Diwali

RE Sunday Cook Out

Art Link

Organizing books/ supplies, helping office staff

Can help on activity days with music, art, storytelling, etc.

Child Health Information: If your child has a health condition, whether physical, developmental and/or emotional that you believe we need to know about that may affect his/her participation in our programming, please communicate with us by filling in the box below and by telling the DREs (Directors of Religious Education) in person.

If your child has an allergy that is life threatening, it is important that you speak directly to the DRE so that reasonable precautions can be taken. Please be aware that there are occasions where parents also provide food and treats at various times of the year for classes and special events. We supply a Sunday morning snack for the preschoolers.

Please understand that the RE program is almost entirely volunteer run and that classroom teachers are volunteer parents, youth and congregation members, who are part of a team that rotates during the church year. We make our best attempts to keep those who need to know informed but consistency of teachers and transmittal of the information cannot be guaranteed.

Number of children:

Child #1

First Name:	*
Last Name:	*
Grade:
RE Time:	9 AM 11 AM Unsure *
Date of Birth:	*
Email:
Allergies:	No Yes (explain below)*
In the following space, please list allergy type and severity. Explain any Physical/developmental/emotional disability or any other issues:

Child #2

First Name:	*
Last Name:	*
Grade:
RE Time:	9 AM 11 AM Unsure *
Date of Birth:	*
Email:
Allergies:	No Yes (explain below)*
In the following space, please list allergy type and severity. Explain any Physical/developmental/emotional disability or any other issues:

Child #3

First Name:	*
Last Name:	*
Grade:
RE Time:	9 AM 11 AM Unsure *
Date of Birth:	*
Email:
Allergies:	No Yes (explain below)*
In the following space, please list allergy type and severity. Explain any Physical/developmental/emotional disability or any other issues:

Child #4

First Name:	*
Last Name:	*
Grade:
RE Time:	9 AM 11 AM Unsure *
Date of Birth:	*
Email:
Allergies:	No Yes (explain below)*
In the following space, please list allergy type and severity. Explain any Physical/developmental/emotional disability or any other issues:

Child #5

First Name:	*
Last Name:	*
Grade:
RE Time:	9 AM 11 AM Unsure *
Date of Birth:	*
Email:
Allergies:	No Yes (explain below)*
In the following space, please list allergy type and severity. Explain any Physical/developmental/emotional disability or any other issues:

Child #6

First Name:	*
Last Name:	*
Grade:
RE Time:	9 AM 11 AM Unsure *
Date of Birth:	*
Email:
Allergies:	No Yes (explain below)*
In the following space, please list allergy type and severity. Explain any Physical/developmental/emotional disability or any other issues:

Child #7

First Name:	*
Last Name:	*
Grade:
RE Time:	9 AM 11 AM Unsure *
Date of Birth:	*
Email:
Allergies:	No Yes (explain below)*
In the following space, please list allergy type and severity. Explain any Physical/developmental/emotional disability or any other issues:

Child #8

First Name:	*
Last Name:	*
Grade:
RE Time:	9 AM 11 AM Unsure *
Date of Birth:	*
Email:
Allergies:	No Yes (explain below)*
In the following space, please list allergy type and severity. Explain any Physical/developmental/emotional disability or any other issues:

Your financial commitment to the church supports RE programming.*
We have already made our pledge for the 2007-2008 church year (no RE fee required)
We have NOT made our pledge for 2007-08. (RE fees: $100/child � $200 max/per family)

Please speak to the DRE if their is financial hardship.

All information will be stored and is confidential, but if you have not pledged for the year than registration will not be considered complete until Perry Montrose, Director of Religious Education, has been contacted.

Permission to Participate in Religious Program, To Travel, & To Photograph
Liability & Emergency Medical Release

As the parent of (child's names)*

I give him/her permission to participate in the RE/Youth programming of the Unitarian Church of Westport, Connecticut. I give permission for her/his photographic/videotape image to be taken and reproduced for educational and informational purposes related to the activities of the Unitarian Church of Westport, Connecticut.

I give permission for him/her to go off church grounds as part of the programming. I understand that when s/he travels off the church property, s/he will be transported in private or rental vehicles which may be driven by volunteers and/or church personnel. I will not hold the Unitarian Church of Westport or any volunteers/church personnel liable for any injuries sustained by my child as a result of his/her participation in the programming or for the loss of their property.

In case of accident or injury to my child, I authorize the representative of the Unitarian Church in Westport, Connecticut to obtain emergency medical treatment, as necessary, as a result of a church-sponsored activity.

Parent/Guardian Name: *

Date: *

2007/08 Family RE Registration Form - The Unitarian Church in Westport

Permission to Participate in Religious Program, To Travel, & To Photograph Liability & Emergency Medical Release

Permission to Participate in Religious Program, To Travel, & To Photograph
Liability & Emergency Medical Release