2015-16 RELIGIOUS EDUCATION REGISTRATION FORM
Peoples Church Unitarian Universalist
This form must be on file in CRE’s Office for your child/ren to participate in our programs
Parent#1 or Guardian Information
Parent #2 or Guardian Information
Name (First/last)
Name (First/last)
Address
Address
City
(
Zip
)
(
Phone (cell/home)
City
)
(
Phone (work)
Zip
)
Email
Email
Youth’s Email
Youth’s Email
I would like to receive the monthly church E newsletter (circle one)
CIRCLE:
MEMBER
FRIEND
VISITOR
(
Phone (cell/home)
Yes
)
Phone (work)
No
How did you hear about us? ______________________________________
Please list all children nursery through high school who will attend our programs
Child’s Name (first & last)
Birth date
Age
Grade
List Allergies / Concerns?
1.
2.
3.
4.
Field Trip Permission
My child/ren named on this form has permission to participate in short field trips during regularly scheduled religious education
classes (walks, visits to other churches, etc.). Church-sponsored youth activities outside of Sunday and Wednesday on-site RE
time use separate permission slips.
Please indicate:
YES
NO
Medical Release
I hereby, as parent or guardian of the minor child/ren named on this form give permission to the Religious Education program staff
or volunteers of Peoples Church Unitarian Universalist of Cedar Rapids, IA in the case of medical emergency to give first aid and/or
take my child/ren to the nearest medical facility or to:
Hospital Preference:
Physician:
Telephone:
I also give the physician and/or hospital permission for any and all procedures necessary for the treatment of my child/ren.
Parent/Guardian Signature___________________________________________
Date________________________
Please continue on the other side ~~~~~~~~~~~~~~~~>
Permission to Photograph/Videotape
I grant permission to RE program staff or volunteers of Peoples Church Unitarian Universalist to photograph or videotape my
children during the normal course of religious education programs for use in promotional materials.
Please indicate:
YES
NO
Annual Religious Education Registration Fee:
Church Member:
$30 for one child annually
$40 for families with more than one child*
Non-member:
$40 a year for one child
$50 for families with more than one child*
Fees help with teacher training and support, curricula and materials, and nursery care provider
training and costs.
Please make checks out to Peoples Church with RE Registration in the memo line. Payments and
registration forms may be returned to Jamie Ray Zaruba-Coordinator of Religious Education in
person, via mail, or to the CRE office. If the latter is your choice, please slip items under the locked
CRE office door for safety of your data.
Classroom/activity volunteers needed! Please mark preference. Thank you, participation supports our youth!
Pre- k
k-2
3-5
6-8
9-12
Any
Leading
Teacher
Assistant
Teacher
Activity
Helper
Thank You!
* Please contact the minister directly to discuss options if this would present a barrier to your family becoming a part of
this welcoming community.