Registrations

If you have any questions about this form, please contact the DRE, Perry Montrose, at perry@uuwestport.org.

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!
For more specifics on the roles, please see the RE Volunteer Opportunities document.
As part of our safe congregations policy, we ask that parents attend for one year before teaching in the classroom. Please consult the UCW Safe Congregation Practices And Policies.
Parent #1 is interested in participating in RE leadership in one of the following areas

Curriculum	Family Outreach
Social Justice	Special Events
Volunteer Outreach	Volunteer Support
Worship

You must check at least one item from each of the following two sections.
Parent #1 can help in the classroom by:

Pre-K Teacher	K-4th Workshop Facilitator
K-4th Group Guide	5-6th Grade Teacher
7th Grade Neighboring Faith teacher	Coming of Age or Our Whole Lives Advisor
High School Youth Group Advisor	Children's Worship Music Leader / Accompaniast
Sunday morning assistant	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 outside the classroom by:

Summer Game Leader	Thanksgiving Service
Passover Seder	Haunted House
Social Event	RE Sunday Cook Out
Parent Coffee	High School Chaperone
Social Justice Helper	Youth Outreach
Children’s Worship Storyteller	Administrative Assistant
Supply Closet Organizer	Librarian

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!
For more specifics on the roles, please see the RE Volunteer Opportunities document.
As part of our safe congregations policy, we ask that parents attend for one year before teaching in the classroom. Please consult the UCW Safe Congregation Practices And Policies.
Parent #2 is interested in participating in RE leadership in one of the following areas

Curriculum	Family Outreach
Social Justice	Special Events
Volunteer Outreach	Volunteer Support
Worship

You must check at least one item from each of the following two sections.
Parent #2 can help in the classroom by:

Pre-K Teacher	K-4th Workshop Facilitator
K-4th Group Guide	5-6th Grade Teacher
7th Grade Neighboring Faith teacher	Coming of Age or Our Whole Lives Advisor
High School Youth Group Advisor	Children's Worship Music Leader / Accompaniast
Sunday morning assistant	I am new to RE, or have special circumstances - please contact me

Parent #2 can also help outside the classroom by:

Summer Game Leader	Thanksgiving Service
Passover Seder	Haunted House
Social Event	RE Sunday Cook Out
Parent Coffee	High School Chaperone
Social Justice Helper	Youth Outreach
Children’s Worship Storyteller	Administrative Assistant
Supply Closet Organizer	Librarian

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 2010/2011 church year (no RE fee required)
We have NOT made our pledge for 2010/2011. (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.

I have read the RE behavioral policy.

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: *

2010/2011 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