RE Registration Forms

Unitarian Universalist Fellowship of Northern Westchester

236 South Bedford Road (Rte 172) P.O. Box 298, Mt. Kisco, NY 10549

Religious Exploration Program Nursery through 12th Grade 2009-10 Registration

Special notes: The registration fee of $75 is waived to all families that have made a pledge in Spring 2009. Financial assistance is available.

All Infants - Youth group members through grade 12 need to be registered below.

Parent/Guardian Information Adult #1_____________________________Adult#2 __________________________________ Street Address______________________Street Address_____________________________ City/State/Zip ________________City/State/Zip_______________________________ Home Phone ___________________ Home Phone ______________________________ Cell Phone ____________________ Cell Phone ________________________________ Email Address__________________ Email Address ______________________________

Children or Youth (First and Last Name) Date of Birth Gender Grade in Sept 09

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please list the first name of your child(ren) and any allergies they have.____________________________________________________________________________________________________________________________________________________________________ Is there anything we should know in order to ensure a positive classroom experience for your child(ren)? (e.g., medical conditions, hearing/visions/attention difficulties) If your child(ren) has an IEP at school, please talk to the Director of Religious Education to make sure we can meet the accommodations needed.

Please give us any additional information we might need to best serve your child(ren) and your family.

I hereby give the UUFNW staff and volunteers permission to release the above information to medical authorities and to obtain medical treatment when I cannot be reached or when delay would be dangerous to my child’s health. I also give permission for my child(ren) to take walks within the Fellowship vicinity with their teachers. I also give permission for pictures of my children to be used on the website and press and marketing materials, as long as their name is not listed.

Signed: Date:

Signed: Date:

We are a volunteer-based program that cannot function without parental support. Each parent is requested to make a contribution of time and energy to the running of the program, either by teaching or assisting in another capacity. Each parent needs to choose and circle one of the commitments below.

Adult #1 Adult #2 Curriculum Teacher (part of a 4 person all year team)Circle One PS-K, 1-3, 4-6, 7-9

Adult #1 Adult #2 Nursery or Youth Group Assistant (part of a team)Nursery, Jr.Youth Group, Sr. Youth Group

Adult #1 Adult #2 Community or Social Action Day Facilitator (on non – Curriculum/worship Sundays; jointly plans and coordinates group activities)

Adult #1 Adult #2 Worship Assistant (assists children’s and intergenerational worship)

Adult #1 Adult#2 Special Activities Facilitator (plans and organizes social action projects, game nights, movie nights, chaperones field trips and overnights, etc.)

Adult#1 Adult #2Data management, supplies, RE Committee, other___________

If you have any concerns about this requirement, please speak to a member of the RE committee or the Minister.

Your signature below indicates that: · you are the parent or legal guardian of the child(ren) listed on this form; · you understand that your involvement in the RE program is required;· and that all the information you have provided is accurate.

Signed: Date:

Signed: Date: