Membership Form

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This is a form to be filled out by people who are completing the Membership Process.

If you are new to River of Grass, welcome! Thank you for visiting our webpage -- we very much appreciate your interest in the Unitarian Universalist faith and in our congregation. Please fill out and submit the Visitor Form and we will contact you with more information. You may also contact us directly at membership@riverofgrassuu.org for more information.

River of Grass UU Congregation Membership Form 2024-2025

If you are new to River of Grass and want to have your name and email added to our online distribution please fill out the form on the Visitor Information Request Page instead of this Membership Form.

If you have been attending our virtual services and are interested in becoming a member of the River of Grass UU Congregation, please fill out the form below and one of the members of our Membership Committee will reach out to you.

* Indicates required field

Name (Member 1): *

First

Last

Birthdate (Member 1): MM/DD/YYYY *

Phone (Member 1): *

Preferred Pronouns (1): *

Email (Member 1): *

Name (Member 2): *

First

Last

Birthdate (Member 2): MM/DD/YYYY *

Phone (Member 2): *

Preferred Pronouns (2): *

Email (Member 2): *

If applicable, names (and ages) of children in household:

Child 1 *

First

Last

Birthdate (Child 1): MM/DD/YYYY *

Child 2 *

First

Last

Birthdate (Child 2): MM/DD/YYYY *

Child 3: *

First

Last

Birthdate (Child 3): MM/DD/YYYY *

Child 4: *

First

Last

Birthdate (Child 4): MM/DD/YYYY *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Is there any other information that you would like to include? (This could be a home number, or any other information you think we should know) *

Membership Directory

Would you like your contact information shared with other members in our Membership Directory? *

Yes: Address, phone, email, and month/day of birthday Yes: Phone, email and month/day of birthday only Yes: Email and month/day of birthday only No Other

If Other selected for directory, please list *

Emergency Contact Information

Emergency Contact 1 (Include First and Last Name as well as a phone number for Member 1's emergency contact) *

Emergency Contact 2 (Include First and Last Name as well as a phone number for Member 2's emergency contact) *

River of Grass UU Congregation Photo Release

Our new virtual presence on the internet has raised some serious concerns about individual privacy. We would like to request your permission to use your name and/or photo(s) and video(s) to help promote our Unitarian Universalist activities and values in the community via communication channels including but not limited to, our website (riverofgrassuu.org), our Facebook page, and our virtual Sunday service. River of Grass recognizes that you may have privacy concerns and would certainly like the opportunity to honor those requests. Please indicate your preferences below, next to the section that applies to you, and then sign and return the document to our office for filing.

Please use the form at our website, riverofgrassuu.org Member page, to electronically complete and submit. Or print and complete the form and mail to 3225 Hiatus Rd., Unit 452485, Sunrise, FL 33345.

Photo Release Form *

Yes, River of Grass Unitarian Universalist Congregation has my permission to use my name, photograph or video, in media, including the River of Grass website (riverofgrassuu.org), Facebook, and virtual Sunday service. I attest that I am of legal age to grant this permission (18 years or older). Yes, River of Grass Unitarian Universalist Congregation has my permission to use my name only (no photographs or videos) in their publicity media. I attest that I am of legal age to grant this permission (18 years or older). Yes, River of Grass Unitarian Universalist Congregation has my permission to use only my first name and photograph/video in their publicity media. I attest that I am of legal age to grant this permission (18 years or older). Yes, River of Grass Unitarian Universalist Congregation has my permission to use my child’s first name only and photograph/video in their media. I attest that I am of legal age to grant this permission (18 years or older). In family photos/videos, use our surname (i.e. the Smith family). No, River of Grass Unitarian Universalist Congregation does not have my permission to use my name and photograph/video, or that of my child’s at this time. I understand that I can change by completing this form again.

Please check all that are applicable.

Role: *

Current Member New Member Friend Visitor Parent of Youth Participant

Please check all that are applicable.

This release is for my entire family: *

Yes No

Please add the names of other adults and minors in your household if this release form is for more that just yourself *

Liability Release: I fully release River of Grass Unitarian Universalist Congregation from any and all liability as a result of my participation in, or that of my child’s participation in River of Grass Congregation publicity and media usage according to permissions granted above.

Thank you and welcome to the River of Grass UU Congregation!

Submit

River of Grass UU Congregation Pledge Card

For the River of Grass UU Congregation Pledge Card, click here.

River of Grass Member Forms

RoG Photo Release Form
File Size:	564 kb
File Type:	pdf

Download File

RoG Friend of Congregation Form
File Size:	123 kb
File Type:	pdf

Download File

River of Grass UU Congregation
11850 W State Road 84, Ste A9, Davie, FL 33325
954.723.7877 - office@riverofgrassuu.org