United Church of Christ

Church School Registration

We are thrilled your child or teen will be joining us for one or more of our events, programs, groups or classes this year! 2015-16 registration is now open.

Please fill out and submit a form for each child in your family. Required fields are marked with a (*). The volunteer section only needs to be filled out once per family.

Don’t want to fill out the form online? Print a copy and either mail it to the church office or bring it to the next church school day or youth event.

Basic Information for 2015-16

Child/Teen's Full Name* (First, MI, Last)

Preferred Name/Nick Name

Date of Birth* (mm/dd/yy)


School Grade Entering*

Parent(s)/Guardian(s) Name(s)*

Parent(s)/Guardian(s) Email(s)*

Street Address*

City, State, Zip*

Home Phone*

Cell Phone(s)

Emergency Contact 1 Name & Phone*

Emergency Contact 2 Name & Phone (Optional)

For teens 6-12th grade, please include the following if applicable:
Youth's Cell Phone & Email (Optional)

Medical Information

Please Describe Any Allergies

Please List Any Medications

Please List Any Existing Medical Conditions or Physical Limitations

Last Tetanus (mm/yy)

Contact Lenses

Family Physician Name & Phone*

Family Physician Address

Insurance Company*

Name on Insurance*

Insurance Policy Number*

Additional Information

Educational/Learning Considerations:
What should our teachers or youth leaders know

Permissions and Consents

1.* I, (parent/guardian name), parent/legal guardian of (child's name), hereby give my child permission to participate in all church-sponsored youth activities taking place during the 2015-16 school year. I accept 

2.* I release the Congregational Church in Exeter, its staff and volunteers, from responsibility and liability for an injury or illness my child may sustain during church-sponsored activities. In the event of an emergency, I hereby authorize as temporary guardian, Catherine Allard - Minister for Christian Growth, or any other church-approved leader to consent in my absence and the absence of other legal guardians, to an x-ray examination, medical, dental or surgical diagnosis; treatment; and hospital care advised and supervised by a physician, surgeon or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either at a doctor's office or in a hospital. I expect to be contacted as soon as possible. I accept 

3. (Optional) I give permission for my child to have his/her picture taken for part of the program and possible display on bulletin boards, church publications, and the church website/facebook pages without his/her name. I accept 

4. (Optional) I give permission for my child/teen to have special arrangements/instructions for pick-up/departure from church school or youth events. I accept 

5. (Optional) (If child is an infant or toddler) I give permission for my child to have his/her diaper changed by staff and/or volunteers in the nursery. Please check to confirm your permission I accept 

*Required Fields