CONtagious 2017 Registration Form
November 3-5, 2017
Sponsored by the Heartland Area Youth Council in collaboration with First UU Congregation of Ann Arbor
Check In begins at 8:00 pm on Friday. Pick-up/departure is at 9:00 am on Sunday.

Location of CON: First UU Congregation of Ann Arbor, 4001 Ann Arbor-Saline Road, Ann Arbor, MI 48103

Complete one registration form per attendee
Youth must be in 9th, 10th, 11th, or 12th grades or the homeschool equivalent AND ages 14-19 (if 19, must still be
enrolled in high school)
Adult sponsors must be at least 25 years of age and have a current background check on file at their home church

Cost: $40 per youth, $30 per adult sponsor (see the following for discounts and scholarship info)
Families registering more than one person qualify for a $5 discount per person
Partial Scholarships are available at $20 for youth/$15 for adults.

Payment:. Make check or money order payable to 'UUAA" and note "CONtagious" in memo line. Mail to:
Mark VanKempen
UUAA
4001 Ann Arbor-Saline Rd
Ann Arbor, MI 48103

Pay online using this link: https://www.eservicepayments.com/cgi-bin/Vanco_ver3.vps?appver3=tYgT1GfNxRUldiimjHMvOWY5XQBku_iDNbQ2T_bOBGHo-7YkZiNiYhc46uwjFenmums9tj3wI7okSf0MyMa8ug6G_QdFm1EJ70zrUDRpZEM=&ver=3

REGISTER EARLY! Registration deadline is Sunday, October 29. Registrations received after this date will be accepted at the discretion of CON planners and will require an additional $5 late fee.

Contact Mark VanKempen at markv@uuaa.org for all registration questions.

Email address *
First Name *
Your answer
Last Name *
Your answer
Address *
Street number, street name, apt #, city, state, zip
Your answer
Phone Number *
with area code
Your answer
Parent Email *
We will use this email to send important CON information and updates
Your answer
Your Email *
We will use this email to send important CON information and updates
Your answer
Congregation *
FULL name
Your answer
Location of Congregation *
City, State
Your answer
Name of your congregation's DRE *
Your answer
Email address of DRE *
Your answer
I am a ___________ *
Age (must be ages 14-19 to attend this CON) *
Adults N/A
Your answer
Grade *
Adults N/A
Your answer
Number of CONs Attended *
Your answer
If you are a youth, what is the name of your adult sponsor?
Your answer
Dietary Preference and Needs *
Required
Allergies
Your answer
Accessibility Needs
Your answer
Health Concerns/Medications
Adult sponsors are responsible for keeping and administering medications during the CON
Your answer
If you are attending as an adult sponsor, are you first-aid trained?
We always need a first-aider on site. It is helpful if it is someone already attending has this training!
If you are attending as an adult sponsor, do you have a current criminal background check on file at your home church?
(If you do not know the answer to this question, check "I'm not sure below" and check with your DRE.
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