Child/Youth Registration

Head of Household

Head of Household Last Name (Required)

Head of Household First Name (Required)

Head of Household Occupation (Required)

Head of Household Work Phone (Required)

Head of Household Relationship to Child (Required)

Head of Household Street Address (Required)

Head of Household City (Required)

Head of Household Zip (Required)

Head of Household Home Phone (Required)

Head of Household 2 Last Name

Head of Household 2 First Name

Head of Household Email (Required)

We frequently communicate via email only. Please keep us up to date so we can keep you better informed.

Child/Youth

Let Us Know About Your Child Or Youth

Please share with us any relevant information you feel we should know about your child or youth. For more children or youth than what is provided for here, please contact us at 503.228.6389 x14

Name of Child/Youth 1

Child/Youth 1 Pertinent Information

Name of Child/Youth 2

Child/Youth 2 Pertinent Information

Name of Child/Youth 3

Child/Youth 3 Pertinent Information

Volunteer

Volunteer Info

Please fill out at least one for each parent/guardian. We will contact you when the event approaches. Your involvement help to make our program a success! Community Learning at First Unitarian Church means that everyone is involved in the journey of education. Adults do not stop learning, and our children are sometimes our best teachers. The expectation is that all parents/guardians will contribute to their child's classroom experience. Once the school year has begun you will be contacted by your child's Room Parent to schedule your dates to be Parent Helper. Each class has only two teachers and for most this is just not enough. Parent Helpers are asked to bring in a healthy snack and then to stay for the session. Please look over the variety of volunteer opportunities being offered and check off as many as you would like!

Work Party

Classroom Cleaning (and more)

Flowers for Childrens Chapel

Food Service for Teacher Training

Pack up and Move (in preparation for construction)

Playground Design Team (for our outside courtyard area)

Mitten Tree, Dec 4-18 (Set-Up, Take Down or Distribution of goods)

Winter Solstice, Dec. 22 (Participate in service or reception)

Seder Dinner, April 15 (Help with potluck buffet, set up, clean up, participate in ritual)

Teacher Holiday Volunteer

Play Day for young children

Jr. Preschool Childcare (by application only)

Library Volunteer (weekdays)

Nursery Childcare (by application only)

Odd Jobs (weekdays)

Office Volunteer/Staff Support (weekdays)

Room Parent - IMPORTANT! (all placements made prior to Oct 3)

Staff Sunday RE Information Table (after service)

Substitute Teacher (previous teaching required)

Co-Teaching 06-07 (by application only)

Medical Information

Health Insurance Provider

Health Policy Number

Preferred Hospital

Doctor

Doctor Phone Number

Emergency Contact Person

Emergency Contact Phone Number

Emergency Contact Relationship to Youth

Youth Waiver

GENERAL TRIP PERMISSION AND MEDICAL WAIVER, FOR YOUTH ONLY When we contact you about registration, we will review the following three consents from parent/guardian:

Youth Consent Intro

I hereby give consent for registered participant listed on reverse side [Registered] to participate in all activities, field trips, outings, sports events and the like, held under the aegis of First Unitarian Church [Church] with my prior notification. I also release Church from any liability for personal injury or loss of personal property, which may be sustained during any such activity or event.

Consent For The Above Statement

Loco-Parentis Intro

I do further extend to the Director of Religious Education, or their designated agent, the power to act in loco-parentis, in securing such immediate emergency treatment as may be necessary for my child's life and comfort, in the event of my absence or unavailability.

Consent For The Above Statement

Expenses Consent

I agree to be responsible for any expenses not covered by my insurance that may be incurred as a result of an accident or medical emergency involving all Registered.

Consent For The Above Statement

Pay Information

Participant, One Child $80

Voting Member, One Child $45

Voting Member, Two or More Children $90

Participant, Two or More Children $160

I would like to be considered for Scholarship

I would like to be contacted about Voting Member Information

I would like to contribute to the Scholarship Fund

First Unitarian Church of Portland

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