Unitarian Universalist Church of Arlington
Official Adult Conference Registration Form for RaCon
PLEASE READ ENTIRE REGISTRATION FORM !!!!
This form must be completed by all Adult participants for each JPD Con.
All Adults must complete an annual Advisor Reference Form.
Please complete and mail postmarked two weeks before the Con to: (Contact Con flyer for price and other specifics)

Davi Rios

 Have you been to a Do You Smoke? Yes No List Youth Advisor Trainings Attended:

930 N Arlington Mill Drive

 JPD Con before?

Arlington, VA 22205

 Yes No Do You Have Experience Working Do you plan to attend any

703 862 6541

 Do You Know CPR or First Aid? with High School-Aged Youth? Future Youth Advisor Trainings?
RaCon@Davi.Rios.org  Yes No Yes No Yes No
Name:________________________ DOB (MM/DD/YY): ___ / ___ / ___ Phone: (___)_____________
Address:____________________________ City:______________________________
State:____ Zip:_______ UU Church (Ex. All Souls or NA):______________________________
Medical / Allergy Info:__________________________________________________________
Medical Insurance Company:__________________________ Policy Number:_____________________
In case of emergency during the Con, contact:_______________________ Phone:__________________
Email: ____________________________________ Dietary Info : Carnivore Vegetarian Vegan AOL/AIM:__________________________________________________________________________

For 1-4 youth it is recommended that an advisor attend the Con. For 5 or more youth an advisor is required to attend for every 5 youth from that congregation. All adults must file an annual Advisor Reference Form with JPD Ofiice
Con Rules
Registration is required for all participants R-E-S-P-E-C-T No Walk-ins or Visits
No Possession or Use of Alcohol or Drugs No Violence or Weapons No Leaving Con Grounds
No Sexual Activity No "Bumming" Cigarettes* "No Means No"
* In Jurisdictions where it is illegal under age 18: No Possession or Use of Tobacco Products
Sleeping Arrangements: Male Quiet Room, Female Quiet Room, "So You Can't Sleep" Room, Drivers' Sleeping Room & Supervised Communal Sleeping Room (Limit one person under any covering)

I, _____________________ (print) have read the above rules and acknowledge them as my guide for participation in this Con, I will follow any additional rules established by the Con Staff and Church Community. I understand that if I break the rules I will be subject to the decision of the Conference Affairs Committee (CAC), including the penalty of being required to leave the Con, and possibly being excluded from future JPDYSC sponsored, and YRUU events.
Signature of Participant: ______________________________ Date (MM/DD/YY):_____/_____/_____

We ask that drivers take the responsibility to attain adequate sleep on Saturday night and to follow traffic regulations. If you are driving, please sign to assure us that you will follow these guidelines.
Signature of Driver: ______________________________ Date (MM/DD/YY):_____/_____/_____

To keep a 5:1 Youth/Adult ratio, we ask that all advisors list the youth they will advise (up to 5). Please list the youth that you will advise and sign to affirm that these are the 5 youth that you will keep in contact with during the Con.
Youth
1.____________________________ 4.____________________________
2.____________________________ 5.____________________________
3.____________________________

Signature of Advisor: _______________________ Date (MM/DD/YY):_____/_____/_____