UR Kids Registration 2009-10

Use this form to register your child to be part of UR Kids for the 2009-2010 school year.

Contact Information * required

First Name *

Last Name *

Home Phone *

Street *

City *

State *

Postal Code *

Parent 1 Name *

Parent 1 Email *

Parent 1 Cell

Parent 2 Name

Parent 2 Email

Parent 2 Cell

UR Kids Age Group *

Age *

Birthday *

Gender *

male female

GROUPIES ONLY: Grade

TOTS ONLY: Child Stage

3-4 Years Old
Pre-k (enters K fall 2010)
Kindergarten

BABES ONLY: Child Stage

6 Weeks through Walking
Walking through 21 months
21 months through 2 years

What would you like for us to know about your child? *

Please let us know of any allergies or other special concerns (i.e. food allergies, asthma, potty training, etc.) we need to know about your son or daughter. If your child has none, then please type “none”.

For children with special needs... *

Please describe any current physical, mental or psychological conditions requiring medication, treatment, or special considerations. If your child has none, then please type “none”.

Photo release and consent...

Please mark this box if you give the Upper Room permission to use pictures and video of your child for promotional/communication purposes. Please note: we will not list your child's name alongside his or her photo.

Yes

Check here if we can contact you regarding serving options.

Because of our growing community, we need parents and families to serve occasionally in some capacity.

Yes