THE GETAWAY REGISTRATION IS OPEN! The Getaway Registration Name* First Last Email* Phone*Sex* Female Male Will you be at least 18 years old on 9/28?* Yes No: YOU WILL NEED TO GET A MINOR RELEASE FORM FROM A STAFF MEMBER Are you a part of a Core group? If so, which one?* I am not part of a Core. Hannah & Savannah Lailah & Whitney Taitum and Bri Lily & Rebecca Mykayla & Kaythryn Andrea & Ro Jessica & Sarah Kaitlyn & Jaryn Cassie & Nive Grace & Madelyn Briley & Eri Inny & Kayla Ava & Ainsley Renee & Arianna Ross & David Ryan & Michael Klein & Tim CK & Juke Felipe & Paul Brian & Boaz Jadon & Xander Laurence & Rohit Nahom & Kai Jacob & Kole Gordon & Daijon Josh & Manny Wilson & Jack Will & Roger Jackson & Jason Emergency Contact Name* First Last Emergency Contact Phone*Please list any dietary restrictions here Please list any medications or conditions we should be aware of in case of an emergency Will you need financial assistance to be able to attend fall retreat?* Yes No Will you be staying overnight?* Yes No Which days will you be attending?* Saturday Only Sunday Only Would you like to pay for The Getaway online now? (You can also pay in person at Fall Retreat.)* Yes, I will pay for UTD Fall Retreat now. - $45 No, I'll pay later. Would you like to pay for The Getaway online now? (You can also pay in person at Fall Retreat.)* Yes, I will pay for UTD Fall Retreat now. - $25 No, I'll pay later. Would you like to pay for The Getaway online now? (You can also pay in person at Fall Retreat.)* Yes, I will pay for UTD Fall Retreat now. - $15 No, I'll pay later. If you would like to include a scholarship to help other students pay for The Getaway, you can enter the amount here. *Once everyone is paid for, any leftover funds will be transferred to the general fund to further the mission of FOCUS. Total $0.00 Credit Card*Card Details Cardholder Name
