SPLATz+ Retreat Registration The Super Powered Lovable Almost Teens and younger Swedenborgian Church Youth Leaguers (SPLATz+) are excited to host a Boston retreat! All youth ages 10 - 15 are invited. At retreats we will look at the theme from a unique Swedenborgian perspective along with wisdom from other traditions. The discussions and activities will be lively and fun. We will also plan and provide a brief presentation during a worship service on Sunday morning. Of course, there will be plenty of time for recreation, great food, exploring, relaxing, and hanging out with friends, both old and new. I hope to see you there! It is very important to note that youth that attend these retreats are not forced or coerced into changing their beliefs. We also do not demand any agreement, or attempt to “convert” youth to our religion. We honor and appreciate everyone’s own individual spiritual path. We share information that we have found helpful in our lives, listen to attendees’ thoughts and beliefs, and learn from each other. Which SPLATZ Retreat Are You Registering For?Select...Fall RetreatSpring Retreat (Stay Tuned)This field is required. Location: Almont New Church Assembly 1513 Cameron Rd, Berlin Township, MI 48002. Dates: May 26, 7 pm - May 29, 10 am Cost: $75 with a household maximum of $150. You can pay using cash, check or online (Zelle or PayPal) . Payment is collected at the end of the registration form. Assistance is available with the cost. Email Kurt at kfekete@hotmail.com! After you register online a medical release form will be emailed to you. Location: Cambridge Swedenborg Chapel, 50 Quincy Street, Cambridge, MA 02138 Dates: November 10, 5 pm - November 12, 1 pm Theme: The Four Elements Cost: $30. You can pay using cash, check or online (Zelle or PayPal) . Payment is collected at the end of the registration form. Assistance is available with the cost. Email Kurt at kfekete@hotmail.com! After you register online a medical release form will be emailed to you. Basic Information How many people will you be registering?OneTwoThreeFourFiveThis field is required. Youth Name of Youth *This field is required. Youth EmailThis field is required. Grade in SchoolThis field is required. Age *This field is required. Special dietary requirements:This field is required.0 characters / 0 words Any other conditions or concerns you would like us to be aware of:This field is required.0 characters / 0 words Name of Second Youth *This field is required. Second Youth EmailThis field is required. Grade in SchoolThis field is required. Age *This field is required. Special dietary requirements:This field is required.0 characters / 0 words Any other conditions or concerns you would like us to be aware of:This field is required.0 characters / 0 words Name of Third Youth *This field is required. Third Youth EmailThis field is required. Grade in SchoolThis field is required. Age *This field is required. Special dietary requirements:This field is required.0 characters / 0 words Any other conditions or concerns you would like us to be aware of:This field is required.0 characters / 0 words Name of Fourth Youth *This field is required. Fourth Youth EmailThis field is required. Grade in SchoolThis field is required. Age *This field is required. Special dietary requirements:This field is required.0 characters / 0 words Any other conditions or concerns you would like us to be aware of:This field is required.0 characters / 0 words Name of Fifth Youth *This field is required. Fifth Youth EmailThis field is required. Grade in SchoolThis field is required. Age *This field is required. Special dietary requirements:This field is required.0 characters / 0 words Any other conditions or concerns you would like us to be aware of:This field is required.0 characters / 0 words Address Address Line 1 *This field is required. Address Line 2This field is required. City *This field is required. State *Select...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingThis field is required. Postal Code *This field is required. Guardian Information Name of Parent/Guardian *This field is required. Phone (Home/Cell) *This field is required. Phone (Work)This field is required. Relationship (must be parent or legal guardian) *This field is required. Parent/Guardian Email *This field is required. I give my child(ren) permission to participate in youth related church activities and drive with church youth leaders, including through Canada if necessary, for the period from September 2023 to September 2024. I understand that it is my responsibility to notify church youth leaders when conditions change which effect the information on the Church Registration and/or Medical Release forms. I give permission to use respectful photos and videos of my child in appropriate publications and/or websites. *YesNoThis field is required. Signature *This field is required.Clear Date/Time *This field is required. Payment Total Cost How will you be paying?Zelle (preferred)PayPal or Credit CardCash or CheckI will contact The Youth Director for assistance at kfekete@hotmail.comThis field is required. Medical Release Form Have you submitted a medical release form since September of this year?YesNoThis field is required. Once you have completed this registration the guardian listed on this registration will be sent a Health History and Permission form over email. Unless your medical information has changed, you only need to submit one medical release form annually. Please ignore the email from docusign. This field is required. Submit