RE Medical Information and Permission Form 2024

Family Last Name(s)

How many children are in your family?

Selected Value: 1

Child's First Name

Please list legal name then (preferred name) if different, list last name if different from the Family Name above.

Email *

Phone *

Main Address *

Address Line 1

Address Line 2

City

State

Zip Code

Additional Caregivers

If there are additional adults who act as caregiver for you child(ren) please provide their: Name, Contact Information and relationship to the child(ren).

Family Rights and Responsibilities

SUPERVISION
At all times when on church grounds, children must be supervised. When children are not in class, caregivers are responsible for their safety. Children age 10 years and younger may not be dropped off without a designated responsible adult present in the building.

DROPOFF / PICKUP
Children age 7 years and younger must be signed in and out of their Sunday School classes by a caregiver or parent. We encourage families with older children to make a plan together related to pickup (i.e. whether your child should wait in the classroom, join the family at snack etc.)

SAFETY
Two non-related, non-partnered adults or one adult and one non-related youth — who have signed our code of ethics and undergone a criminal background check — will lead each Sunday School class with special care and attention to the needs of all participants.

PROGRAM KNOWLEDGE
Families are invited to seek information about our curricula, philosophy, methodology, and policies regarding safety and behavior. Caregivers / parents are welcome to visit during most classes, aside from older OWL / Get Real sexuality education classes which are limited to participants and facilitators.

ASSUME BEST PARENTING
We have a variety of parenting styles and beliefs about good parenting at First UU. At times this may create conflicts between families. Please assume best parenting intentions, aside from actual verbal or physical abuse, which must be reported.

CONFIDENTIALITY
Sensitive concerns that you share with the RE staff, teachers or volunteers will be confidential, except as mandated by state law for reporting or as necessary to save lives.

REGISTRATION
Children and youth must be registered each year, providing current contact and emergency information, permission to participate, and any information we need to keep them safe and engaged (such as medical or behavioral needs, gender identity, trauma history.)

FINANCIAL SUPPORT
A regular pledge based on your finances is expected of each family, whether adults choose to become members or not. Your generosity makes our programs possible! Adults becoming members also encourages our Coming of Age youth to do so.

TIME AND TALENT SUPPORT
Volunteering in RE is expected.

We recommend that caregivers be part of a teaching team at least every third year to better understand the program; and to take on lesser roles in other years. Your help makes this community possible! Thank you!

I have read and agree to the Family Rights and Responsibilites. *

Agree

Preferred Providers

Primary Physician's Name *

Primary Physician's Phone *

Dentist's Name *

Dentist's Phone *

Specialist's Name

Specialist's Phone

Preferred Hospital

if other than Children's fill in hospital name

Preferred Hospital's ER Phone

if other than children's fill in hospital number

Front of Medical Insurance Card *

Click or drag a file to this area to upload.

Please upload a photo of the back of your primary medical insurance card.

Back of Medical Insurance Card *

Click or drag a file to this area to upload.

Please upload a photo of the front of your primary medical insurance card. If you family has multiple insurances or none please let RE staff know.

Vaccination Status *

My child(ren) is(are) current on their vaccinations according to the CDC schedule
My child(ren) is(are) NOT current on their vaccinations.

Permission for Treatment

I give my consent for the emergency medical treatment of my child(ren). I give my consent for all information in this and the class/camp registration form to be provided to those providing treatment. In the event of illness or injury requiring emergency treatment, I wish for church authorities and volunteers to make reasonable attempts to contact all emergency numbers listed in this form. In the event that no parent or guardian listed can be reached, I hereby give my consent for the administration of any treatment deemed necessary by these designated, preferred practitioners. In the event that preferred practitioners are not available, treatment by another licensed professional and /or transport to my preferred hospital or any hospital reasonably accessible is authorized:

*This authorization does not cover major surgery unless the medical opinions of two licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.

Consent *

I consent to treatment
I do not consent to treatment

Permission to Participate

By signing below I grant permission for my child(ren) to participate in Religious Exploration programming for the 2024-2025 church year.

Name of Parent/Guardian Signing *

First

Last

Date Signed *

First UU Church of Columbus

First Unitarian Universalist Church

Services: in-person & streaming
Sundays at 10am

Family Rights and Responsibilities

Preferred Providers

Permission for Treatment

Permission to Participate

First UU Church of Columbus

First Unitarian Universalist Church

Services: in-person & streamingSundays at 10am

RE Medical Information and Permission Form 2024

Family Rights and Responsibilities

Preferred Providers

Permission for Treatment

Permission to Participate

Services: in-person & streaming
Sundays at 10am