Children & Youth Programs Registration Form

Pacific Central District - UUA District Assembly 2008, Apr. 25-27

Please copy and paste page 1 into an email,

complete the information and send to us at:

pcd@pcd-uua.org

 

Parents’/ Guardians’ Name(s): 

Address:

City:

State:

Zip:

Phone:

Email:

Congregation:

Please check each applicable day and time -

NURSERY: Child’s name and age:

 

__ Friday 7– 10 pm, ___ Saturday 8am – 5:30pm, ____ Saturday 7-10pm, ___Sunday 9-12

 

RAINBOWS: Child’s name and age:

 

__ Friday 7– 10 pm, ___ Saturday 8am – 5:30pm, ____ Saturday 7-10pm, ___Sunday 9-12

 

Kids: Kid’s name and age:

 

__ Friday 7– 10 pm, ___ Saturday 8am – 5:30pm, ____ Saturday 7-10pm, ___Sunday 9-12

 

MUUGS: MUUG’s name and age:

 

__ Friday 7– 10 pm, ___ Saturday 8am – 5:30pm, ____ Saturday 7-10pm

 

HIGH SCHOOL: Youth’s name and age:

 

 

 

Please Note: No Registrations for Child & Youth programming will be taken after April 11th!

Please see the next page for Parent /Guardian Consent and Medical Release

 Form & Youth Sponsor Form

Parent/Guardian's Consent and Medical Release Form

All participants under the age of 18 MUST have the Medical Release form -

Please complete ONE Medical Release Form PER Child / Youth!

 

Note: we must have a hard copy of this page with original signature on file at DA2008.

Please print this form after filling in the information, sign, and bring with you to DA2008!

 

 

I, (Parent / Guardian’s Name) am the parent/guardian of (Child / Youth’s Name),

 

who will be attending the Pacific Central District Assembly from 25-27 April, 2008. I hereby give my consent and authority for the District Assembly staff to take any action they deem necessary to help ensure the safety, health, and welfare of my child / ward. I also give my consent for any medical treatment, including surgical care if it is needed.

 

Signature:

 

Date:

 

Emergency Contact Number (cell phone if possible):

 

Health Insurance Company:

 

Policy Number / Group Number:

 

Special Needs or Concerns:

 

MUUGS & DYGT / YRUU (12-18 years old) Sponsorship Form

All youth aged 12 – 18 must have this sponsorship form!

 

If you are a youth (12-18 years) attending District Assembly, you and your parent(s) / guardian(s) need to fill out the following information and return it to the District Staff. Pacific Central District Assembly is not a YRUU-sponsored event. This means that you need to have an adult sponsor who is also planning to attend District Assembly. This adult can be a parent, a member of your congregation, or a UU friend over the age of 25. Being your sponsor means that this adult is taking responsibility for your well-be­ing, safety and best interests.

Each adult can sponsor up to three youth.

 

 

Name of Youth:

 

Name of Sponsor:

 

Relationship to Youth:

 

Sponsor signature:

 

 

Date: