UUFCC Winter Retreat 2027

Retreat Attendee Name

Retreat Attendee Preferred Name and Pronouns

Retreat Attendee Address

Retreat Attendee Phone

Retreat Attendee Email

Does the Retreat Attendee have any medical conditions, allergies or dietary restrictions? In what ways can we best support your spiritual, mental, and physical health needs at the retreat?

Emergency Contact Information

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relationship to Retreat Attendee

How are you attending the retreat?

Are you/your family coming Friday-Sunday or Saturday only?

I/We are attending Friday-Sunday I/We are attending Saturday only

If you are attending for the weekend, are you sharing a cabin with others? Yes No

Who are you sharing a cabin with? *(Non-family members need to fill out their own registration form)

What activities would you like to do at the retreat? Are there activities you would be willing to lead or assist in leading?

Additional Family Members Attending the Retreat with You

Additional Family Member 1 Name

Additional Family Member 1 Preferred Name and Pronouns

Additional Family Member 1 Relationship to Retreat Attendee?

Additional Family Member 1 Phone (if adult)

Additional Family Member 1 Email (if adult)

Additional Family Member 1 Age (only if a minor)

Does Additional Family Member 1 have any medical conditions, allergies or dietary restrictions? In what ways can we best support their spiritual, mental, and physical health needs at the retreat?

Additional Family Member 2 Name

Additional Family Member 2 Preferred Name and Pronouns

Additional Family Member 2 Relationship to Retreat Attendee?

Additional Family Member 2 Phone (if adult)

Additional Family Member 2 Email (if adult)

Additional Family Member 2 Age (only if a minor)

Does Additional Family Member 2 have any medical conditions, allergies or dietary restrictions? In what ways can we best support their spiritual, mental, and physical health needs at the retreat?

Additional Family Member 3 Name

Additional Family Member 3 Preferred Name and Pronouns

Additional Family Member 3 Relationship to Retreat Attendee?

Additional Family Member 3 Phone (if adult)

Additional Family Member 3 Email (if adult)

Additional Family Member 3 Age (only if a minor)

Does Additional Family Member 3 have any medical conditions, allergies or dietary restrictions? In what ways can we best support their spiritual, mental, and physical health needs at the retreat?

Additional Family Member 4 Name

Additional Family Member 4 Preferred Name and Pronouns

Additional Family Member 4 Relationship to Retreat Attendee?

Additional Family Member 4 Phone (if adult)

Additional Family Member 4 Email (if adult)

Additional Family Member 4 Age (only if a minor)

Does Additional Family Member 4 have any medical conditions, allergies or dietary restrictions? In what ways can we best support their spiritual, mental, and physical health needs at the retreat?

All parents/caregivers are responsibile for their own minor children during the UUFCC Winter Retreat.

Liability Release and Medical Treatment Permission

LIABILITY RELEASE
I/We, the undersigned, agree and hereby release and agree to hold harmless UUFCC and/or any and all supervisors and volunteers (collectively herein: Fellowship) from any and all liability, claims, or demands for any accidental personal injury or sickness, as well as property damage and expense of any nature incurred by the Participant(s) while involved in UUFCC activities, including, but not limited to, any damages, loss, or injuries that may be sustained through participation in the retreat. I/We hereby assume all risk of accidental personal injury, sickness, damage, and expense as a result of participation in any UUFCC activities at Krislund. The undersigned further hereby agrees to hold harmless and indemnify said Fellowship for any liability sustained as the result of the negligent, willful, or intentional acts of said Participant(s).

MEDICAL TREATMENT PERMISSION
I/We hereby authorize the Fellowship, hospitals, licensed medical/ dental providers, and their agents and employees to have access to the information contained in this form and to provide all medical/ dental.care, routine tests, treatment, and necessary transportation advisable for the health and safety of the Participant(s). This includes the authority to any x-ray exam, anesthetic, medical procedure/treatment, and hospital care under the supervision, and upon the advice of or to be rendered by a licensed physician, surgeon, or dentist. For minors, as parent(s)/legal guardian(s), I/We remain legally responsible for the Participant(s) and hold harmless the Fellowship for any cost of medical treatment in connection with any and all UUFCC retreat activities.

Name(s) of Participat(s) agreeing to the Liability Releases and Medical Treatment Permission

Date Signed

Health Care Information

Name of Family Physician/Practice

Physician/Practice Phone Number

Physician/Practice Address

Medical Insurance Provider Name

Name of Policy Holder

Policy/Group #

If any members of your family have different health insurance, please list the details here (if relevant):

Each attendee is responsibile for their own prescription medication(s). No one affiliated with UUFCC will administer or hold prescription medications for attendees.

Photo Permissions

Photographic images of those participating in the retreat may be featured on the church website uufcc.com and in other church related online and print media. Names are never published. If you wish to Opt-Out of having your/your family's photos published, please select opt-out below.

(optional) UUFCC photo inclusion Opt out - no photos please

Financial Sponsorship Options

If you are willing to sponsor another family's retreat participation, please check the following: I would like to sponsor $190 for a cabin fee for another participant/family I would like to sponsor a weekend registration and facility fee of $50 for another participant I would like to sponsor a day option of $25 for another participant I would like to make a general contribution toward the retreat at a donation amount of my choosing (specify below)

Donation amount of my choice

Rock Climbing Sign-up

I would like to reserve a spot/spots for myself/my family for the rock-climbing activity at $10/person (cash only, pay day of event, Saturday, Jan 30) Yes, I would like to sign up No, I will skip this activity

UUFCC Winter Retreat 2027

Description

Please Fix the Following