Unitarian Universalists of Clearwater

Religious Education for Children and Youth

Fall Program Registration for 2009-2010

(Classes begin September 13, 2009 at 10:30 am)

Pre-K thru 5th grade: ‘Tapestry of Faith’

Youth 6th grade and up: ‘Messages in Music’

Parents(s)/Guardian _______________________________________________________________

Address _________________________________________________________________________

street city state zip code

E-mail ___________________________________________ Phone _________________________

Name of Child/Youth #1 ___________________________________________________________

Grade as of 9/1/09 ____ Date of Birth_____________

Interests, special needs ____________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Name of Child/Youth #2 ___________________________________________________________

Grade as of 9/1/09 ____ Date of Birth_____________

Interests, special needs ____________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Name of Child/Youth #3 ___________________________________________________________

Grade as of 9/1/09 ____ Date of Birth_____________

Interests, special needs ____________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Please complete the other side, too!

2

Throughout the church year, there will be opportunities for photos to be taken of children and youth.  Should the photos be displayed on the church website they will not be identified by name to ensure the safety and privacy of our children and families.

Please make a selection below:

____ YES I grant the ministers and volunteers of the Unitarian Universalists of Clearwater permission to photograph my child(ren).

____ NO I do not grant the ministers and volunteers of the Unitarian Universalists of Clearwater permission to photograph my child(ren).

________________________________________________________________ _____________

signature of parent/guardian date