Sr. High -- Our Whole Lives Retreat Registration & Information Form
Deadline to register is Feb. 1- unless it fills before there is a limit of 20 youth
Please thoroughly review the details below and complete the questions and permissions at the end.

Sponsored by:
First Congregational Church, UCC

Dates:
Thursday Feb. 28 - Saturday March 2. Meet at Church approx. 5:00 pm, and return to church approx 11:30 am

Staff Lead:
Pastor Kendra Joyner Miller cell: 331-315-9566

Adults Attending:
Ally Vertigan
Andy Livingston
Kelly Kallinich
Damon Holst


Overnight Accommodations at:
Pilgrim Park UCC Outdoor Ministry
26449 1340 N. Ave
Princeton, IL 61356
http://www.il-odm.org/home/

OUR WHOLE LIVES is a comprehensive sexual education program that was designed by the UCC and Unitarian Universalist Association to address sexuality from a holistic standpoint.

We are children of an amazing Creator beautifully and wonderfully made. What does it mean to see our sexuality as more than mechanics but as part of our mind, our body, and our spirit?

Packing List:
1. Sleeping bag and pillow
2. Towels & washcloth
3. Toiletries
4. Pajamas/sleep clothes
5. Outdoor appropriate clothes and boots for playing in the snow
6. Water bottle
7. Journal/ Bible
8. Favorite Games (cards/ board games etc.)

Times below are approximate. A confirmation e-mail will be sent to attendees with confirmed times closer to the event.
Thursday, Feb. 28, 2019
- 5:00 pm - meet at FCCGE for check-in & load vans

Saturday, March 2, 2019
- 11:30 am - meet at FCCGE for check-out & unload vans

The fee is $150 for the program (includes lodging, food, supplies). If any hardship, there is a scholarship available. Please contact Kendra@fccge.org

Youth Information & Permissions
The below information will be kept safely and only distributed to leaders of groups involved. This form allows First Congregational Church, UCC Glen Ellyn vital medical information for our records along with permission for use of photos and communication. To attend this event please fill in the form below BEFORE or on January 29th. Without this information and permission, youth may not attend.
Youth's First Name *
Your answer
Youth's Last Name *
Your answer
Name(s) of Emergency Contact(s) *
Your answer
Relationship(s) of Emergency Contact(s) *
Your answer
Phone Number(s) of Emergency Contact(s) *
All that apply, such as home, work, cell, other
Your answer
I give permission for my son/daughter to attend *
Please type the name of the parent or guardian completing this information and giving permission.
Your answer
Medical & Health Information
Any Medication should be handed into the main leader and it will be supplied when needed, if the medication needs to be carried by your son/daughter this must be agreed with the organizers. All information will be kept confidential, we cannot accept responsibility for any information not declared.
Please list any allergies (especially food), if none, please indicate "None" *
Include all allergens/foods with severity of reaction, sensitivity (ex. ingestion only) and if the youth will be attending this event with medications.
Your answer
Any special dietary needs? *
If so, please describe, otherwise indicate "None"
Your answer
Do you have any current or on-going medical conditions such as asthma that require medication? *
If none, then indicate "None," otherwise list condition and medication name and dosage information if applicable.
Your answer
Please list any physical limitations or restrictions that may impact the youth's participation in this event, if none, please indicate "None." *
We will be sitting for lengths of time and having free time that can involve physical games, and sleeping in a social hall with sleeping bags and using public restrooms.
Your answer
I give permission for First Congregational Church, UCC Glen Ellyn to publish anonymous photos and/or videos of participant in church publications and on-line social media. *
Is there any additional information that would assist our leaders in providing a safe, welcoming and fun environment and event for the participant? *
If not, please respond "None"
Your answer
Our church strives to be a loving place where all feel welcome and safe. We want to truly live into the Apostle Paul's call to be members in the "Body of Christ" lifting one another up in ways that reflect the love of God. This being said we understand the incredible pressures that youth fell all the time about what to put into their bodies. When we are on church related retreats that pressure is removed- you do not need to worry about pressure or expectation of others. There will be no use of alcohol- illegal substances- or tobacco on church trips. There will also be no pressure or expectation around sexual activity. We encourage the building of wonderful healthy relationships with others but on church trips we focus on building the entire community. Sexual activity is also not tolerated. If there is a violation of either of these the youth will be sent home at the parent's expense- either by parents coming to get their youth (if in driving distance) or by other arrangements being made. *
Have you already submitted a photocopy of your current health insurance card for the 2018 - 2019 program year? *
Please check the appropriate box
If you have new health insurance information, a photocopy of the front and back of the medical insurance covering the participant will be required to participate.
Please check the appropriate box
Our Whole Lives participation history: *
Please select one
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