COA Retreat Registration [Youth]
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: $110
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 via 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 a youth participant 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
Home Phone *
Your answer
Cell Phone *
Your answer
Email Address *
Your answer
Birthday *
Grade *
Gender *
Your answer
Your answer
Diet *
Housing Preference *
Allergies or Dietary restrictions *
Other special needs *
Your answer
Health Insurance Provider *
Your answer
Health Insurance Policy & Group # *
Your answer
To insure the best possible experience, please tell us of any limitations, characteristics, or behavioral issues which could help retreat staff in working with your youth**: *
Your answer
Youth requiring medications must use the medications form found on the webpage containing this form.
My youth is bringing medications and I will complete the medication log. *
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