R E G I S T E R  H E R E

First Name

Last Name

Phone Number

I am a:
Male
Female

School
UCF
Valencia College
Another university/college
I'm not a student

I'll be graduating:
Fall 2024
Spring 2025
Fall 2025
Spring 2026
Fall 2026
Spring 2027
Fall 2027
Fall 2028
Spring 2028
I'm an alumni
I'm not a student

Small Group Leader(s)
Kayla
Caelynn & Kayla
Abigail
Ryan & Luke
I'm not in a small group

Are you an international student?
Yes
No

T-Shirt Size:
XS
S
M
L
XL
XXL
XXXL

Fall Retreat:
I've been before!
I've never been!

Allergies, Health Concerns, or Dietary Restrictions?

I need special accommodations:
Handicap Accessibility
Spanish-English Translation
Sign Language Translation
Other Accommodations
I don't need special accommodations

Full Name of your Emergency Contact

Emergency Contact Relationship to You

Phone Number of your Emergency Contact

The earliest I can leave for Fall Retreat on Friday the 29th is:
1 pm
2 pm
3 pm
4 pm
5 pm
6 pm
7 pm
8 pm
9 pm
After 9 pm

Getting to Fall Retreat:
I need a ride
I can drive myself and 0 others
I can drive myself and 1 other
I can drive myself and 2 others
I can drive myself and 3 others
I can drive myself and 4 others
I can drive myself and 5 others

I personally assume all health risks including but not limited to COVID-19 and understand I will be in a room with up to 3 other students.
I agree

I agree if I can no longer come, I need to email XA staff at xaatucf@gmail.com by September 15th to receive a refund. After this date, I am no longer eligible for a refund.
I agree