Winter Escape 2015 Retreat - Unitarian Universalist Young Adults Near the DC Area
In order to request registration, please fill in the following information, noting especially the required fields.  * Not all registrations may be accepted. *  The organizers will promptly reply with an email confirmation regarding your registration status (Accepted, Not accepted, Pending, Waiting list).  If accepted, then the reply email will also contain information about how to make your payment (rate is $89).  

Full refunds are guaranteed for any reason if requested by 1/7/15.  After 1/7/15, full refunds are available only if there are people on the waiting list to take the requester's place.  "Winter Escape" is an annual 4-day/3-night social and spiritual retreat for Unitarian Universalist Young Adults (ages 18-35+) near the Wash., DC area.  The 2015 event will be from 6pm Fri 1/16 to 10am Mon 1/19.

Information link:  https://sites.google.com/site/winterescapeuu/
Join the UUYADC meetup group!:  http://www.meetup.com/UU-Young-Adults-in-the-DC-Area/
Join us on Facebook!:  http://www.facebook.com/groups/190601480974287/

Sign in to Google to save your progress. Learn more
- Basic Information -
First Name *
Last Name *
Email Address *
Cell Phone *
xxx-xxx-xxxx
Address Line 1 *
(Street Address)
Address Line 2
(Street Address Continued, Unit #, etc.)
City *
State *
Zip Code *
Age *
(As of the start of the retreat weekend)
Gender/sex *
Home Congregation *
(The congregation you most affiliate with)
Emergency Contact Name *
Emergency Contact Relationship
Emergency Contact Phone *
xxx-xxx-xxxx
- Food-Related -
Diet *
Please select all that apply.
Required
Food Allergies/Other Dietary Restrictions
Food Duty *
Everyone is required to help with at least one meal preparation or cleanup - pick your preference below
- Medical/Accessibility -
Environmental Allergies
Accessibility Requests
Medications
Allergies to Medications
Other Medical Conditions
- Housing-related -
Bedding Arrangements *
There are many twin/single beds and full/double beds available.  Please check any options that would work for you.  If you want to share a bed or to room with someone specific, please also fill in the name in the follow-up box below.  If we are unable to accommodate your request, we will let you know beforehand.
Required
Bedding Specific-Person Request
If you request to share a bed with a specific person, or to bunk or room with one or more specific people, then please enter the name(s) of the people you want to share or room with.  [If possible, these person(s) should also mention you in their registration(s).]
I prefer to be in a ____ room *
We will try to accommodate this request.  However, if we are unable to accommodate, we will let you know beforehand.
I prefer to be in a ____ cabin (...regarding sound level) *
There are four cabins and the main lodge.  There may be a "late-night" house and/or a "quiet" house as options.  If we are unable to accommodate your request, we will let you know beforehand.
I prefer to be in a ____ cabin (...regarding food) *
People who have particular food restrictions or preferences may choose to stay together in the same cabin.  Or not - one need not eat in the cabin he/she stays at.
Required
Preference - main lodge or smaller cabin? *
About half of the attendees will stay (i.e., sleep) in one of the four cabins, and about half will stay in the main lodge, where many of the activities will take place.  Which arrangement might you prefer?
Required
- Transportation -
Transportation *
Please select your preferred transportation from the DC Metro Area and back; gas cost will be coordinated with drivers.  Parking space will be somewhat limited, so carpooling is encouraged (and may be necessary).  Plus it's fun to talk with your fellow UU's along the way :)
# of Passengers (...mindful of space needed for bags)
If you can drive there, please say how many OTHER people you could take, NOT including yourself. [Please remember to factor in any space needed to bring stuff!]
Nearest Metro station *
Nearest Metro station to you, and what Line it is (helps for arranging carpool pick-ups)
Departure Time (approx.) *
Please write the approx. ideal time you'd depart from DC area towards the retreat.  [Of course this is just a guess, since the trip is still many weeks away, but just a guess is good for now.]
Post-retreat plans, Mon 1/19 (approx.) *
Do you want to get back home as soon as possible, or spend part of the day on more post-retreat activities?  [Of course this is just a guess for now.  Many people even decide during the weekend itself.]
- Miscellaneous -
Do you know First Aid or CPR? *
How did you first find out about this event? *
Required
I want to help!  (volunteer in any way)
As per your interest, please select any box(es) below to help in any way.
Workshops / Activities !
If you'd like to plan and/or run any specific kind or name of activity, you can indicate your interest below :)  There will also be plenty of time to volunteer to lead a workshop/activity later on.
Financial Assistance / Scholarship
If you need financial assistance, you can fill out the "Scholarship Request Form," though assistance is not guaranteed.  Please indicate below if you request to receive the "Scholarship Request Form," and the organizers will send you the form separately after receiving your registration request.
Agreement and Signature
Agreement with the below statements is required if you want to register and attend Winter Escape 2015.
Signature - Covenant *
By typing your full name in the box below, you indicate that you agree to honor the Covenant.  Agreement is required for registration and attendance.  "Winter Escape is a welcoming and affirming community in which participants seek connections with each other and the diverse range of sources of meaning.  In order to promote justice and harmony within our community, we agree to:  Treat each other, our space and its surroundings with respect.  Resolve conflict in a non-violent manner.  Support and assist community members in need to the best of our ability.  Establish mutual consent for any physical contact between community members.  Not bring any hard liquor or illegal drugs to the retreat.  If a member of the community violates this covenant, he or she may be asked to leave the retreat immediately and without a refund."
Signature - Personal Liability Statement *
By typing your full name in the box below, you indicate that you agree to honor the Personal Liability Statement.  Agreement is required for registration and attendance.  "Personal Liability Statement: UU Young Adults and the organizers of this event will not be held liable for losses in any form that may occur at Winter Escape.  The registrants/attendees assume all liability for their property and personal well-being at all times."
Signature - Weather Statement *
By typing your full name in the box below, you indicate that you agree to honor the Weather Statement.  Agreement is required for registration and attendance.  "Weather Statement: UU Young Adults and the organizers expect the event to take place rain or shine, and even in the rare case of very inclement weather the organizers will make every effort to host the event in some form, though there are no absolute guarantees. The state park must be paid for the weekend whether or not the weather is good, so paid registrants will not receive refunds just due to weather conditions that may limit or force cancellation of the retreat."
Any Other Comments
If there is any other information or suggestions you'd like to share with us, please provide it here.
Submission of a request for registration does not guarantee registration.  Payment is done separately later on.
Not all registrations may be accepted.  The organizers will promptly reply with an email confirmation regarding your registration status (Accepted, Not accepted, Pending, Waiting list).  If accepted, then the reply email will also contain information about how to make your payment (rate is $89).

If you want a copy of your filled-in registration form, then please print this registration page for your records (or after Submitting, you can also hit "Back," to still print it).  Hope to see you at WE'15!
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms