COA Retreat Registration [Chaperones]
Registration for COA Retreat, October 4-6, 2019, Friday 7:00 PM through Sunday 1:00 PM
Location: UBarU
Grades 8-10 (or equivalent); 11-12 may participate if first time taking Coming of Age
Cost: No Cost
Registration Deadline: September 15, 2019
After you have registered, you will receive an email with an attachment. Be sure the email you supply is regularly monitored.
Print out the attachment and supply the necessary signatures, then return this form to your religious educator.
If you don't have one, scan and email to Carrie Krause,
In addition, bring completed hard copies of forms with you to the retreat.

*****Prior to attendance at UUA youth events, all participants must disclose any child welfare agency investigation or any criminal or juvenile delinquency arrests, charges, convictions including those involving abuse, violence, sexual misconduct, domestic violence, child abuse, driving while intoxicated or under the influence, firearms or dangerous weapons or similar matters. UUA may deny or limit participation based on any of these disclosures.

Email address *
Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Best Phone contact *
Your answer
Email Address *
Your answer
Gender *
Your answer
Your answer
Diet *
Housing Preference *
Allergies or Dietary restrictions *
Other special needs or health issues we should be aware of *
Your answer
Health Insurance Provider *
Your answer
Health Insurance Policy & Group # *
Your answer
Emergency contact, relationship, and phone number *
Your answer
I would be interested in leading one or more of the pre-planned workshops over the weekend. *
I grant permission for photos and videos of myself to be published on designated Unitarian Universalist websites for purposes relating to youth events. *
I understand that UBarU, the host churches, their staff, and the adult or youth staff of the event do not assume any liability for me, and I hereby release them, individually and collectively, of such liability. In the event that an emergency should arise, I grant permission to those in charge to do whatever is deemed necessary to secure my safety and well being, and I hereby authorize in advance any necessary medical care. I agree to be responsible for any such medical expenses. *
Never submit passwords through Google Forms.
This form was created inside of Live Oak Unitarian Universalist Church. Report Abuse - Terms of Service