SUUS FAITH FORMATION REGISTRATION FORM: CHILDREN AND YOUTH 2020-2021

Parent or Guardian #1

Name

This address will receive a confirmation email

Phone

Address

Parent or Guardian #2

Name

Phone

Address

Child Information

Child’s first and last name:

Date of Birth:

Grade as of Sept 2020

Medical Concerns /Allergies*

* Please list all allergies, including food, animals, pollen, insects, medication, etc., and note any treatment that could be required at church.

#2 Child’s first and last name:

Date of Birth:

Grade as of Sept 2020

Medical Concerns /Allergies*

#3 Child’s first and last name:

Date of Birth:

Grade as of Sept 2020

Medical Concerns /Allergies*

Getting To Know Your Child Better

Are there any family circumstances we should be aware (e.g., custody issues)?

YES NO

If yes, please describe.*

Are there any learning or developmental differences that might affect your child’s classroom experience?

YES NO

If yes, please describe.*

Does your child have a learning style and/or any physical or emotional challenge that may affect their behavior in our programs?

YES NO

If yes, please describe.*

*Please note: If you prefer to speak directly with the Director of Faith Formation and/or Minister regarding your child, please be in touch to schedule a meeting prior to participation in SUUS programs.
Amy Buckley: dff@shorelineunitarian.org
Rev. Jeanne Lloyd: minister@shorelineunitarian.org

Is there anything else that we should know about your child that would help us serve them better?

Privacy

Information Sharing - It is our intent to treat the information on this form with sensitivity and care, while ensuring that adults who have responsibility for your child(ren) have the information they need. This information will be shared as needed with program volunteers and staff. If you have an objection to the sharing of any information in this manner, please specify:

Photo/Video Release and Signature - Occasionally, we like to take pictures or videos of the children as they participate in class or other SUUS activities. Such images may be posted in a classroom, on a bulletin board, on the SUUS website or facebook page, in the newsletter or promotional materials, or in other print or online publications, such as district and UUA publications and local newspapers or news websites. We do not publish or display names or other identifying information with photos, without first obtaining parent/guardian permission.

Please indicate whether or not you give consent for the use of your child(ren)'s images as indicated above. You may revoke or alter this permission at any time with written notification to the Director of Faith Formation (dff@shorelineunitartian.org).

YES, I give consent for SUUS to use my child(ren)'s images as indicated above. NO, I do NOT give consent for SUUS to use my child(ren)'s images as indicated above.

Electronic Signature

If you do NOT want your child’s picture used in this way, please indicate any restrictions here:

In Case of Emergency

If I/we cannot be readily located in the event of an emergency, I/we authorize SUUS and its representatives to render emergency medical assistance to my child(ren)and to authorize medical and paramedical personnel to do the same.

I/we further give permission for my child(ren) to leave the SUUS under the supervision of program leaders for walking trips and related activities during the Sunday morning program (field trips outside of class time or requiring transportation will use a separate permission slip).
I/we also understand that, although SUUS follows policies and practices that it believes to be reasonable to protect children, injuries may still occur. I/we release SUUS and all its representatives from any and all claims and liability for any injury to any child of mine, and agree to indemnify and hold SUUS and all of its representatives harmless against any such claims and liability.

Electronic Signature

To provide the very best programming for our children and youth, many adult volunteers are needed each year. Please consider how you can help, and let us know your interests and preferences. The Director of Faith Formation is available to discuss the details of any of these possibilities.
Our program needs you!

Adult Volunteer Options Teach/assist/substitute in a class Support teachers by setting up classroom supplies Do occasional shopping for FF supplies Become a Faith Formation Committee Member Plan/lead/assist a “Social Justice Sunday” workshop Help with communication about the program (eg, bulletin board, email) Assist with volunteer recruitment and support

Plan/assist Special Events Halloween Party Mystery Pen Pals Holiday Caroling Other community-building events

What specific talents or resources might you offer?

Thank you for taking the time to fill out our online registration!
If you have questions or would like further information,
please contact:
Amy Buckley, Director of Faith Formation (dff@shorelineunitarian.org)
Or Faith Formation Committee Co-Chairs:
Benna Lehrer, Faith Formation Co-Chair (bennalehrer@yahoo.com)
Kathy Helmrich, Faith Formation Co-Chair (kahelmrich@yahoo.com)

SUUS FAITH FORMATION REGISTRATION FORM: CHILDREN AND YOUTH 2020-2021

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