2025-26 9th-12th grade Senior Youth Group: Religious Education for Children and Youth Registration

9th-12th Grade: Senior Youth Group

Youth will engage in leadership challenges that will deepen their UU faith, create lasting relationships, and explore the importance of congregational & community involvement.

Please fill out the form and click the "Submit" button. You will receive a confirmation email once submitted.

Child's Information

Name

Pronouns

Birthdate

Allergies

Please select all that apply.

None Peanuts Tree Nuts Gluten Antibiotics Stinging Insects Shellfish Strawberries Eggs Dairy Other

Other Allergies or Food Preferences

Are there any topics that are tender for your child, for which they would need extra support?

Consent to obtain or provide Emergency Medical Treatment?

Please select one option.

Yes No

May photos of your child be taken and used for UUSS program purposes, including posting on the website or in a brochure? We will never identify your child by name.

Please select one option.

Yes No

If your child has special needs, you're welcome to contact the Director of Lifespan Religious Education at dlre@uuschenectady.org or (518) 374-4446 x 6 to share best ways to support your child.

Caregiver Information

Caregiver #1 Full Name

Phone

This address will receive a confirmation email

Caregiver #2 Full Name

Caregiver #2 Phone

Caregiver #2 Email

Caregiver #3 Full Name

Caregiver #3 Phone

Caregiver #3 Email

It would be helpful to have at least two contact people for each child, and to know your preferences for whom to contact first, if you have a preference. Please provide two full names, their relationship to the child, and the best phone number for those people. The contact people may include you or a spouse, or may also be a relative, neighbor, family friend, etc.

Primary Emergency Contact

2nd Emergency Contact

Optional Donation for Senior Youth Group Funding

Please select all that apply.

Yes

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

2025-26 9th-12th grade Senior Youth Group: Religious Education for Children and Youth Registration

Description

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