Northwest UU Relgious Education Registration
Please fill out this form and click submit.
Child's Name
*
Child's Birthday (mm/dd/yyyy)
*
Child's Grade
*
Please select one option.
Infant/Toddler
Preschool
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
School
Email
*
This address will receive a confirmation email
Contact Phone Number
*
Alternate Contact Phone
Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Second address
Parent/Guardian Name
*
Parent/Guardian Name
Does your child have allergies?
Does your child have any health concerns or special needs?
What interests or other information about your child should we know?
Do we have permission to use your child's photograph on social media or the church website?
*
Please select one option.
Yes
No
Submit
Description
Please fill out this form and click submit.
×
Please Fix the Following