SPRING 2026 Unitreat: INDIVIDUAL REGISTRATION FORM

Event: SPRING UNITREAT May 8-10, 2026
Location: Lutherdale, Elkhorn, WI

Name of Your Unity (or New Thought) Chapter

Attendee Legal Name (First and Last)

Preferred First Name (for Nametag)

Participant Grade:

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

9th-12th grade registrants: I understand that by registering I have been approved by the Region to attend the event as YOU staff vs. a regular participant.

I understand Not Applicable

Participant Birthday

Gender

If other, please specify

Pronouns (optional)

Cabin Preference (participants will bunk with others of the same gender identity. If you prefer a gender neutral sleeping area, please specify.)

Male Female I prefer a gender neutral cabin 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 Attendees, write N/A)

Relationship to Youth (e.g. mother, father, grandparent, etc.)

Parent/Guardian Phone Number (Adult Attendees, write N/A)

Parent/Guardian &/or Adult Participant Email Address

This address will receive a confirmation email

Participant's Primary Address

Participant Phone Number (Adult Required, Youth optional-can write n/a

How many Unity Youth Retreats/Rallies Previously Attended?

0 1-2 3-5 5-10 >10

DIETARY INFORMATION & LIMITS TO PARTICIPATION

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 ADD/ADHD Other Not under a Doctor's Care

If other,or special care needs, please list:

Participant's Current Medications

Medication Name, Amount taken (Dosage) and time(s) of day to Dispense (e.g. breakfast, evening, etc.) If none, write- "NO MEDS TAKEN"

Parent/Guardian: Please list which over-the-counter medications are OK to Dispense 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

Parents/Guardians: Please note that prescription medications for minors must be turned over to adult leaders with clear usage instructions at all Regional youth events.
-This means a prescription bottle for that individual with their name, medication, and dosage.
-If a medication is "As Needed", your minor(s) must understand the symptoms of their condition and be capable of asking for help from adult leaders.

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 (e.g. father, mother, grandparent, spouse, friend, etc.)

Medical Insurance Company Name

Medical Insurance Phone Number

Policy Holder's Name

Insurance Policy Number

Family Physician (Optional)

Family Physician Phone Number (optional)

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

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 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 Attendee

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 imperartive 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.

Uniteen Heart Agreement

Y.O.U. Staff Heart Agreement

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

Electonic 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

By checking this box, I indicate that all information provided on this form is complete and accurate to the best of my knowledge.

Description

May 8-10, 2026 (deadline Apr 5th)

Welcome to the Great Lakes Unity Youth Retreat Registration Page.
--Before registering, please 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 youth, 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 availalbe 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 are a youth director/designee in charge of registration, please first fill out the group registration form here: https://glr.breezechms.com/form/ab28d82

If you have questions about this form or process, contact Cassidy at yfmcoordinator@greatlakesunity.com or at 406 490 4459

Registration is set to close at midnight Central Time on Sunday April 5, 2026

SPRING 2026 Unitreat: INDIVIDUAL REGISTRATION FORM

Description

Please Fix the Following