Religious Education Registration

Special Notice: Religious Education classes for children, Pre-Kindergarten through 12th grade, are offered during the 11:15 service only. Childcare is available at 9:15. Nursery care for children ages 3 and under is available during both services.

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Otherwise, you will send partial data to the RE program

Today's Date

Yes First time registration for MVUC RE program
No

			2011/12
STUDENT NAME(S)	BIRTH DATE	YOUTH E-MAIL	SCHOOL GRADE	SCHOOL

RE Communications

We prefer to receive communications by E-mail.
We prefer to receive communications on paper through postal mail. Parent/Guardian Information

Primary Contact

Last Name, First Name

Street

City, State, Zip


Home Phone	Work Phone

E-mail address

Secondary Contact

Last Name, First Name

Street

City, State, Zip


Home Phone	Work Phone

E-mail address

Ours is a cooperative Religious Education (RE) program. In addition to support of the RE program through pledges or direct financial contributions, parents are also expected to contribute some of their time and effort to RE. Please sign up for AT LEAST ONE of the following: Use initials to indicate which adult is volunteering. Thank you!

Teach on Sunday morning	Be a substitute teacher
High School Youth Advisor	Help with Winter Holiday Play
Help with Children's Worship	Serve on the Religious Education Council and help with planning and implementing policy decisions and program direction
Help with Multi-generational special events such as the Big Boo (Halloween) Party or the Holiday Craft Workshop

Indicate any special interests or skills you would like to offer:

Pictures: Occasionally pictures are taken of RE classes and activities that may be used by Mt. Vernon Unitarian Church in various publications to member and/or public audiences to promote MVUC's programs.

I grant permission for my child(ren)'s photograph to be used: in any MVUC publication

Or in the following formats only:
in RE brochures and informational materials
in the MVUC newsletter (sent to subscribers)
on the MVUC web site

I DO NOT grant permission for my child(ren)'s photograph to be used in any way by MVUC

Special Needs Please indicate if your child has any special needs (e.g., allergies, physical limitations, learning disabilities, chronic health conditions or is taking medication which affects his or her behavior) so that we can prepare properly. Use the area below to explain. This information will be provided verbatim to your child's teacher. Thank you.

Optional Medical Information: You may complete the following medical information form, which will be used in connection with field trips and off-campus activities. If completed, you may avoid submitting this info for each field trip if you check the “current information filed electronically with RE Registration” box on each field trip permission form. If you have more than one child in RE, please indicate the child's name that goes with the information, e.g., John:0123456 Susie:0123457.

My child's health insurance provider is:
The person who is the primary name on the policy is:
My child’s medical record number is:
Youth’s known allergies/medical concerns:
Medication taken regularly: