Middle School Southern Cluster Retreat Registration Form 2017
Middle School Youth Southern Cluster Retreat
September 30-October 1, 2017
Arrival: 2:00pm EST Saturday
Departure: 2:00 pm EST Sunday
YMCA Camp Piomingo
1950 Otter Creek Park Rd.
Brandenburg, KY 40108
Contact DRE Linette Lowe at First Unitarian Church of Louisville, KY with questions: dre@firstulou.org (502) 489-4972.

Complete one registration form PER ATTENDEE, including adult sponsors.
Youth must be in 6th, 7th, or 8th grades or the homeschool equivalent.
Adult sponsors must be at least 25 years of age and have a current background check on file at their home church.

Cost: $85 per youth, $55 per adult sponsor.
For information on partial scholarships, please contact Linette Lowe directly.
We accept cash or checks made out to First Unitarian Church of Louisville (with "Middle School Retreat" in the note section). We apologize that we are unable to process credit cards at this time.
Registration fees can be brought to check-in on Saturday afternoon OR mailed to:
First Unitarian Church of Louisville
Attn: Linette Lowe, Retreat
809 S. 4th Street
Louisville, KY 40203

Registration deadline is SEPTEMBER 11. Registrations received after this date will be accepted at the discretion of retreat planners and will require an additional $10 late fee. NO registrations will be accepted after September 15.

Contact Linette Lowe at dre@firstulou.org for all questions concerning registration.

Looking for YOU to join us on Retreat!!
First Name
Your answer
Last Name
Your answer
Congregation
FULL name
Your answer
I am a/an ___________
Full Adress
Street number, street name, apt #, city, state, zip
Your answer
Phone Number
with area code
Your answer
Parent/Guardian Email (if you are an adult sponsor, please provide your own email)
We will use this email to send important CON information and updates
Your answer
Age
Adults N/A
Your answer
Grade
Adults N/A
Your answer
Number of retreats you have attended
Your answer
If you are a youth, what is the name of your adult sponsor?
Your answer
Dietary Preference and Needs
Allergies
Your answer
Accessibility Needs
Your answer
Health Concerns/Medications
Adult sponsors are responsible for keeping and administering medications during the retreat.
Your answer
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