Family Faith Development Registration Form

Parent/Guardian Name

Relationship to Participant

Additional Parent/Guardian Name (If applicable)

Relationship to participant

This address will receive a confirmation email

Main Phone Number

Addition Phone Number

Address

Child 1 Name, Pronouns, Date of Birth, Grade, Allergies/Special Needs/Other

Child 2 Name, Date of Birth, Grade, Allergies/Special Needs/Other

Child 3 Name, Date of Birth, Grade, Allergies/Special Needs/Other

Child 4 Name, Date of Birth, Grade, Allergies/Special Needs/Other

Please check to acknowledge your preference for photographs and videos.

I, the parent/guardian, grant permission for UUCLV to use any photos and/or videos without identifying information (name, age) of the above-named child(ren) for social media, advertisement, or inhouse publication. I, the parent/guardian, grant permission for UUCLV to use any photos and/or videos with identifying information (name, age) of the above-named child(ren) for social media, advertising, or inhouse publication. I, the parent/guardian, do NOT grant permission for UUCLV to use any photos and/or videos of my child(ren) for any purpose.

I, the parent/guardian of the above-named child(ren) grant permission to UUCLV to take her/him/them outside on the UUCLV grounds during RE classes. If I cannot be contacted, I grant permission to the supervising adult to authorize necessary emergency medical treatment. I agree to be responsible for any expenses that may be incurred as a result of an accident or medical emergency involving the abovenamed child(ren).

YES NO

Electronic Signature*

*By entering my name in the box above, I am providing my digital signature on this form.

Description

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Family Faith Development Registration Form

Description

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