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

Davi Rios

 Have you been to a Do You Smoke?

930 N Arlington Mill Drive

 JPD Con before? Yes No

Arlington, VA 22205-1330

 Yes No Would you like a DYSC Caravan

Phone: 703 862 6541

 Are you a youth leader of YRUU? to come to your church?
Email: RaCon@Davi.Rios.org 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. Make sure your adult has filed the annual Advisor Reference Form with JPD Office

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):_____/_____/_____

Consent Form If Under 18 Years

I, _____________________ (print) am the parent/legal guardian of ________________ who will be attending the RaCon with _____________________ (advisor) on May 7 - 9. I herby give my consent and authority for the Con Staff to take any reasonable action to help insure the safety, health and welfare of my child. I also give my consent for any necessary medical treatment, including emergency surgical care if needed. I will cover the costs incurred. I understand that my child will be required to follow the rules of the Con, and that a breach of those rules may result in my child being sent home at my expense.
Signature of Parent/Guardian: _____________________________________ Date (MM/DD/YY):_____/_____/_____