2026 YOU Fall Rally and Fall Unitreat: INDIVIDUAL REGISTRATION

If Other, Please Specify

PARTICIPANT Legal Name (First and Last)

Preferred First Name (for Nametag)

Participant Grade (Fall 2026)

6th 7th 8th 9th 10th 11th 12th Adult

Participant Birthday

Participant Gender

If other, please specify

Pronouns (optional)

We recognize that some participants' experience of their gender (aka their gender identity) is different from their sex assigned at birth. At Regional youth retreats, participants bunk with others of the same gender identity.

Cabin Preference (select all that apply)

Male Female I prefer a Gender Neutral I am willing to bunk in a gender neutral cabin

T-Shirt Size (adult sizing)

S M L XL 2XL 3XL

Parent/Guardian Name (Adult Participants, write N/A)

Relationship To Youth

If other, please specify

Parent/Guardian or Adult Participant Phone Number

Parent/Guardian or Adult Participant Email Address

This address will receive a confirmation email

Participant's Address

How many Unity REGIONAL Youth Retreats/Rallies Previously Attended? Not including sub-regionals or lock-ins at your local church

0 1 2 3-5 6 or more

Please List Names of any Family Members Attending with Participant (siblings, cousins, parent/guardian, etc.) We aim to put family in different small groups, but will put family members of the same gender in the same cabin).

DIETARY INFORMATION & LIMITS TO PARTICIPATION

Meal Selection

Standard Vegetarian Vegan Gluten-Free

Other Intolerances or Food Allergies

Please note which, if any, of the above allergies are life threatening

The above-named participant is in good health and is able to participate in all event activities. Please select one option.

Yes No - see limitations below

Describe limits to participation (if any)

Participant is currently under a Doctor's supervision for: (select all that apply)

Epilepsy Diabetes Asthma ADHD Other Not under a Doctor's Care

Other special care or requests for accommodations, please explain here. We will do our best to accommodate each person's needs so they are comfortable and fully able to participate.

Youth Participant Current Medications

Parents/Guardians Note: All medications, prescription or otherwise (except for inhalers & epi-pens) must be secured by an Adult leader or the Wellness Team for the entire weekend.
***ALL medications (including over the counter meds taken 'as needed') must be listed below and transported in the original container, all contained in a clear zip-lock baggie CLEARLY labeled with the youth’s name, church, type of medication, dosage and when needed. Only send the amount of medication needed for the weekend.***
Youth are responsible for going to their Leader or the Wellness Team for their medication.

Name of Youth Medication 1 (if none, write N/A)

Medication 1: Dosage

Medication 1: Instructions (e.g. time of day taken, with or without food, etc.)

Name of Medication 2

Medication 2 Dosage

Medication 2: Instructions

Additional Medications: name, dosage and instructions

Parent/Guardian: Please list which over-the-counter medications are OK to offer to this minor if needed. Aspirin Acetaminophen (e.g. Tylenol) Nasal Decongestant (e.g. Sudafed) Pepto Bismal, Tums or Pepcid Ibuprofen (e.g. Advil, Motrin) Cough Suppressant (e.g. cough drops) All can be given. None of the above can be given

Allergies to Medicine? If yes, please describe

MEDICAL INFORMATION

Emergency Contact Name (must be different than parent/guardian name listed above)

Emergency Contact Phone Number

Emergency Contact Relationship to Participant

Parent/Guardian Step-Parent Grandparent Aunt/Uncle Other Relative Spouse (adult participants only) Friend (adult participants only)

Medical Insurance Company Name

Medical Insurance Phone Number

Policy Holder's Name

Insurance Policy Number

Family Physician (If applicable)

Family Physician Phone Number (if applicable)

Approx. Date of Participant's Last Tetanus Shot

CONFIDENTIALITY

I understand that health information on this form will be secured and will only be shared, as needed, with adult leaders, church staff and medical professionals to safeguard and support the participant. This information will not be publicly disseminated

Liability Release: Please Read Carefully

Parent/Guardian
As legal guardian of the above-named minor, I hereby give permission for my youth to participate in this event and to travel to/from the event location.
Whenever it may be deemed necessary, I authorize the calling of a doctor and/or the providing of other necessary medical services and, unless covered by insurance, agree to pay for same.
I understand that reasonable measures will be taken to safeguard the health and safety of young people and that I will be notified as soon as possible in case of emergency.
Should the Local Chapter and Great Lakes Region accept this minor as a participant, I agree to indemnify and hold harmless from responsibility the Church, the Association of Unity Churches (Unity Worldwide Ministries), the Great Lakes Region of the Association, their employees, volunteers, agents, representatives and group leaders from any injury, illness (including COVID-19 and any variant) or property damage involving the above-named participant, no matter how caused.

I hereby attest that I have read the complete document; all information is complete and true: I have legal standing to make decisions which affect the rights of the above named participant: and I understand and consent to all terms outlined in this registration document.

TRANSPORTATION:
I understand that my church group will be responsible for and inform me of the mode of transportation for this event. I agree to send my child with the appropriate clothes, personal items, and money needed.
If my child needs to be sent home for behavior problems or medical reasons, I agree it will be at my expense.

Parent/Guardian Electronic Signature* (Adult Attendees, write N/A)

*By entering my name in this box, I am providing my digital signature on this form

Liability Statement - Adult
I hereby voluntarily and knowingly assume all risks and dangers inherent and incidental to the Unity Worldwide Ministries Great Lakes Region (the Region) events and activities and travel, understanding that some activities may pose a risk of injury. I understand that reasonable measures will be taken to help ensure my health and safety. Whenever it may be deemed necessary, I authorize and consent to the calling of a doctor and/or the providing of other medical services and, unless covered by insurance, agree to pay for same.

I agree to indemnify and hold harmless from responsibility, the Association of Unity Churches Inc. (d/b/a Unity Worldwide Ministries(UWM)) the Church/Ministry, and the Region and its volunteers, designees, employees, agents and event/youth group leaders for any injury, illness (including COVID-19 and any variant) or property damage, no matter how caused.

I have read this complete document and I understand and consent to all terms contained herein.

TRANSPORTATION:

I understand that I am responsible for the mode of my transportation for this Event. If I need to be sent home for any reason, including breach of the Event Sponsor Heart Agreements or medical reasons, I agree it will be at my expense.

Adult Electronic Signature (parent/guardian, write n/a)

*By entering my name in this box, I am providing my digital signature on this form

PHOTOGRAPHY RELEASE

I hereby grant Unity Worldwide Ministries Great Lakes Region and it's representatives permission to use photographs and videotaped images from this event in which my child or I appear, in any manner whatsoever, such as but not limited to publication, display, advertising, slide shows, etc.

Parent/Guardian AND Adult Participant

I agree I do not agree

HEART AGREEMENTS

Important: Please carefully read through the heart agreements together with your youth (if you are a parent/guardian) and with your adult if you are a youth.

Adult participants must also read through these carefully to better understand your role in serving our young people.

These agreements are essential to ensuring a safe, fun event for all involved.

Click on the link to the Heart Agreement that applies to you.

Once you have read through the agreements, both youth and their parent/guardian (and adult participants) will sign below indicating your willingness to uphold these heart agreements.

Y.O.U. Heart Agreement

Uniteen Heart Agreement (6th-8th grades)

Electronic Signature - Youth (all others write n/a)

Electronic Signature - Parent/Guardian (all others write n/a)

Adult Heart Agreement

Electronic Signature - Adult Participant (all others write n/a)

What is the 3rd heart agreement (ok to summarize)?

Email Address of the person from your church/chapter organizing this event (they will receive a copy of this form)

Leadership Opportunities

These are special opportunities for youth and adults to serve the event/Region. Application forms and leadership descriptions are availalbe on the Great Lakes Unity Region's website here. https://www.unitygreatlakesregion.org

I am a teen who has attended at least two previous Regional retreats and am interested in: Applying to be a Family Group Leader

Teen Participant Phone Number (if you are interested in leadership opps)

Email Address (to send you an application)

I am an adult participant interested in: Leading the All Adult Family Group Leading a Unitreat Spirit Group Being on the Wellness Team Being on the Head Sponsor Team Being an event Photographer Other - please Specify

If other, please specify

Description

Nov 6-8, 2026. Deadline Oct 412

Welcome to the Great Lakes Unity Youth Retreat Individual Registration Page.
Event: Fall Retreats: Y.O.U. RALLY & UNITREAT Nov 6-8, 2026
Location: Lutherdale Camp, Elkhorn, WI
REGISTRATION DEADLINE: SUNDAY OCT 4th, 2026 @ 11:59 PM CT

--Before registering, make sure you have been in communication with your church's YFM contact and/or minister and that you have their permission to attend this event.
--Both youth and adult participants will use this form to register.
--If you are a teen, please make sure your adult is available to review and sign their sections.
--If you are a parent/guardian registering your youth, please make sure your youth is available to review and sign their section (heart agreements)
--If you are registering more than one family member, please submit registrations one by one using this form

If you have questions about this form or process, contact Cassidy Meeks, yfm@unitygreatlakesregion.org or (406) 490 4459
Submit your payment to your local church and they will submit one payment to the Region.

2026 YOU Fall Rally and Fall Unitreat: INDIVIDUAL REGISTRATION

Description

Please Fix the Following