Creating Community Retreat — ADULT & SPONSOR REGISTRATION

Who are you registering?

I am registering as:

Adult participant (ages 18–19) Sponsor / chaperone (21+)

Participant Information

Participant full legal name

Preferred name

Date of birth

Address

This address will receive a confirmation email

Phone

Address

T-shirt size

Dietary needs (e.g. vegetarian, gluten-free)

Emergency Contact

Emergency contact full name

Relationship to participant

Emergency contact phone number

Overnight Basics

Dietary restrictions or food allergies

Are there any immediate medical concerns we should be aware of at check-in?

Yes No

(Full medical details will be collected in the required Medical Release & Care Form.)

Agreements & Expectations

Please read and acknowledge each item below:

I have read and agree to the Unity Heart Agreements. I understand this is an overnight retreat and that all participants are expected to follow behavioral and substance-free expectations. I understand that participation requires completion of a Medical Release & Care Form.

Photo and video consent

I give permission for photos/videos to be taken and used for Unity Lynnwood purposes. I do not give permission for photos/videos.

Consent Acknowledgment

Typed names serve as acknowledgment and consent.

Participant full name

Payment

Retreat fee ($125)

Optional contribution to support youth participation

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

January 2-4

Creating Community is an overnight Unity Lynnwood retreat focused on connection, reflection, and shared experience across generations.

Dates: January 2–4
Drop-off / Registration: Friday, January 2, 3:00–5:00 pm
End of Retreat: Sunday, January 4, following the 11:00 am service (approximately 12:30–1:00 pm)

This is a mixed-age, overnight retreat.

Participant categories:
• Youth participants: under 18
• Adult participants: ages 18–19 only
• Sponsors / chaperones: 21+

Saturday Evening Activity:
On Saturday evening, the group will travel off site for a supervised roller skating outing. Transportation will be provided by Unity Lynnwood, and all participants will return to the retreat site the same evening.

⚠️ Important:
A completed Medical Release & Care Form is required for ALL participants (youth, adults, and sponsors). A link will be provided after registration.

For questions, contact: Stacie Baley at Stacie@UnityinLynnwood.org or Grace Golgert at YouthandFamily@UnityinLynnwood.org

Creating Community Retreat — ADULT & SPONSOR REGISTRATION

Description

Please Fix the Following