Kent Washington Stake	Comfort Suites & Family FUN CENTER

		All fields with a red asterisk * between the text label and input fields are REQUIRED. If the requested information does not apply to you, please enter the text 'NA' or 'none'.

Participant Information
for help with registration data requested, mouse-over the associated label below
First Name:	*
Last Name:	*
Birth Date:	*
		Note: When selecting your birth date, please pick date parts in the following order: MONTH - YEAR - DAY
Are you a Laurel or Priest?	*	* Select Class/Quorum Laurel Priest
Please Specify Your Home Ward:	*	* Select Your Ward Kent Branch (SPN) Clark Lake Ward Crestwood Ward Lake Meridian Ward Lake Sawyer Ward Park Orchard Ward Scenic Hill Ward Kent - Other
Participant Email Address:	*
Participant Mobile Phone:
		Note: Please use one of the following phone # formats: 000-000-0000, 000.000.0000, (000) 000-0000, 0000000000
Street Address:	*
City:	*	Kent | Covington | Auburn | clear
State:	*
Postal Code:	*
		Note: Please include dashes for US 9 digit zip codes (ex. 10001-1001)
Home Phone:	*
		Note: Please use one of the following phone # formats: 000-000-0000, 000.000.0000, (000) 000-0000, 0000000000
		Personal Conduct Contract: Read this carefully. You must agree to and fulfill this contract to attend the retreat. I agree to uphold the standards of The Church of Jesus Christ of Latter-day Saints and the following rules of conduct: Follow the direction and counsel of my stake & adult leaders and class instructors. Uphold all church standards of good language, sportsmanship, modest dress, cleanliness, Word of Wisdom, and all other conduct of good behavior as outlined in the For the Strength of Youth pamphlet. Attend & participate in all scheduled events, activities, classes, projects, meetings, etc. Leave ALL electronics (MP3 players, computers, tablets, games, game consoles, etc.) at home except for your personal cell phone. When asked by my stake leaders, I will temporarily surrender my cell phone to them as required for specific activities. Have good manners, respect for others’ rights, respect all personal and public property, and special respect for any facilities where I will be a guest. I will present a positive attitude and uplifting demeanor at all times. I will specifically respect the Comfort Suites and Family FUN CENTER, in which I will be a model guest. I will not roam the hotel and will adhere to the "lights-out" policy. If I need to leave the retreat early, my parents should notify the stake leaders in advance. I will not leave the hotel or fun center without parental & leader permission. Transportation from the Church will be by the stake leaders – youth are not permitted to drive between the Church and the Comfort Suites & the Family FUN CENTER. I understand that if my behavior warrants removal from any activity at any time, I will not be able to participate in the remainder of Priest Laurel Retreat and my parents will be responsible for taking me home.
Hotel Roommates:
		List two friends (priest/laurel age) from the stake that you would like to have as a roommate (girls list girls, boys list boys - make sure they plan to attend and will be registered also). We will try to put you with at least ONE friend from your list. Enter your friend names and select their associated ward (this is optional but highly recommended):
Friend #1 and Ward:		CL    CW    LM    LS    PO    SB    SH
Friend #2 and Ward:		CL    CW    LM    LS    PO    SB    SH
Parent/Guardian Information
Parent/Guardian's Name #1:	*
Parent/Guardian's Email Address #1:	*
Parent/Guardian's Mobile or Work Phone #1:	*
		Note: Please use one of the following phone # formats: 000-000-0000, 000.000.0000, (000) 000-0000, 0000000000
Parent/Guardian's Name #2:
Parent/Guardian's Email Address #2:
Parent/Guardian's Mobile or Work Phone #2:
		Note: Please use one of the following phone # formats: 000-000-0000, 000.000.0000, (000) 000-0000, 0000000000
Medical Information
Do you have any of the following:	*	Special diet Allergies Medication Chronic/Recurring illness Surgery or a serious illness in the past year Physical conditions that limit activity
If yes, please explain.
Permissions & Agreements
		Participant Agreement I declare that the above statements are complete and correct, and agree to keep my part of the "Personal Conduct Contract". I also understand that I and/or my parent/guardian may be contacted with important retreat-related information via email or text message (if mobile phone # provided). CHECK THE BOX TO CONFIRM   Parental Permission I give permission for my child/youth to participate in the activity outlined above and authorize the adult leaders supervising this activity (including host-family parents) to administer emergency treatment to the above-named participant for any accident or illness and to act in my stead in approving necessary medical care. This authorization shall cover this activity and travel to and from this activity. CHECK THE BOX TO CONFIRM   Photography/Video Permission I, the parent/guardian, agree to allow my youth to be photographed and/or video to be taken for the use of this retreat and other youth programs. CHECK THE BOX TO AGREE
Having problems or have questions?		Contact: [email protected] (general & website-related questions).

		Once you have entered the requested information and provided the needed permissions, please click the 'Submit My Registration' button below. Upon successful completion, you will be sent a confirmation email with a link to the Church's Parental or Guardian Permission and Medical Release form in which a parent/guardian will need to sign and date. Bring this completed form with you to the retreat on Friday, November 10th and provide to a stake leader at check-in. We look forward to seeing you at the retreat!
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