REGISTRATION 2018 LEYM ANNUAL SESSIONS 7102018
Each person attending Annual Sessions needs
a separate registration form,
including children 3 and under.
It is important that every person attending be registered so that housing assignments can be made, meals are available, and program needs can be met.
Registration Deadline for Children (0-18) is July 9, 2018.
All children are welcome, toilet-trained or not.
Registering all children by the deadline allows adults working with them to make sure all are appropriately cared for.
* designates a required field
Registrant Information E-mail a question to the registrar
First Name* Report a technical issue
Last Name*
Street Address
City
State Select OH, MI, PA, or other
Other State Type your state
Zip
Phone* Use format xxx xxx-xxxx
E-mail* Enter the e-mail address you want messages sent to
Young Adult (19-35)* Adult (36+)* Child (0-18)*
Child's Age at LEYM* Enter a number from 0 to 18
Child's Date of Birth For LEYM records
0-3, 3-7, 8-18, or 19+
Meeting or Worship Group Select your LEYM meeting/worship group or select "other" at the end of the list
Meeting/YM or Organization If you are a visitor to LEYM, enter your meeting & yearly meeting or organization
First time attending LEYM Annual Sessions (LEYM Friends only)
LEYM Job If working a pre-arranged job during Annual Sessions, select the job
Lodging
Rates
Children 18 & under free courtesy of LEYM
Per Night
Ramseyer $ 23.50 Air conditioned; pillows & blankets
Bren-Dell $ 18.50 No A/C, no pillows or blankets
Camping $ 10.00 Your equipment
Per Day
Commuting $ 5.00 Not staying overnight on campus
Per Stay
Linens (dorm rooms only) $ 10.00 2 sheets, 2 towels, soap, wash cloth
Where*
Dorm or other*
Linens For dorms
With Whom*
I prefer to room alone
Please room me with:
Teen rooming with family with teens
How many rooms for family?
Mobility
Trouble with stairs
Trouble walking
Use wheelchair
When*
Thursday Friday Saturday Click in each box
Ramseyer Adult
Ramseyer Child
Bren-Dell Adult
Bren-Dell Child
Camping Adult
Camping Child
Commuting Adult
Commuting Child
Sunday (commuters only)
Commuting Adult Sunday
Commuting Child Sunday
Meals
Rates
Children under 3 are not charged for meals. LEYM will cover 2/3 of the cost of meals for those aged 3-18.
Breakfast Lunch Supper
8 and older (before discount) 6.40 8.95 10.20
3-7 (before discount) 5.00 6.75 7.75
Click in each box
Thursday Friday Saturday Sunday
Breakfast Breakfast Breakfast
Lunch Lunch Lunch Lunch
Supper Supper Supper
Vegetarian
Charges
Registration Charges
Rates (for adults only)
Registration through 7/9 $ 55.00
Late fee (after 7/9) $ 10.00
Registration
Late fee (after 7/9) If a late fee is shown for a child, check that "Child" is selected and you have entered an age from 0-18
Worker Registration Scholarship
Final Registration Fee
Lodging Charges
Lodging/Commuting charges
Linen charge
Worker lodging scholarship
Final lodging charges
Meal Charges
Meal charges - Adults
Meal charges - 8-18 If not calculating, check that "Child" is selected and you have entered an age from 0-18
Meal charges - 3-7
Worker meal scholarship
Discount for children (ages 3-18) - 2/3 off cost
Final meal charges
Total Charges
Total charges
Discount for first-time attender
Donation to help others attend Enter an amount here if you'd like to help others attend
Amount due Bring a check made out to "LEYM" and present it when you sign in for Annual Sessions.
Paying by check is the only option.
Type any comments in the box below:
LEYM Parent or Guardian Consent & Permission
Parent/Guardian First Name
Parent/Guardian Last Name
Cell phone Cell phone you will be carrying (xxx xxx-xxxx)
Home address If different than above
If someone other than a parent or guardian is accompanying the child/teen:
First Name
Last Name
Cell phone Cell phone adult will be carrying (xxx xxx-xxxx)
E-mail Enter the address to use for any questions
Home address If different than above
Nickname (if any)
Child's First Name Copied from above
Child's Last Name Copied from above
Child's Age at LEYM Copied from above
Child's Grade Level Next Fall
T Shirt Size:
Youth S Youth M Youth L
Adult S Adult M Adult L
Adult XL
Medical, mental, and physical conditions:
Full list of medications currently taken:
Medical Insurance*
Insurance Carrier Please also bring a copy of your insurance card & present it when you sign in for Annual Sessions.
Group number
Policy holder's name
Policy number
Consent & Permission
I am aware that my child is attending the gathering of Lake Erie Yearly Meeting at Bluffton University, Bluffton, OH, on July 26 - 29, 2018.
I authorize the adult staff to arrange for emergency medical care they deem necessary.
I am aware that for my child to participate in swimming, bowling, or any other off-campus activity he/she will be riding in a private motor vehicle to and from these activities.
My child will only ride in vehicles equipped with seatbelts or age appropriate child-restraining devices. (Providing your child's car seat would help.)
*Parent/Guardian's Full Name By typing your name here, you
confirm that this is your signature.
If parent/guardian is not attending LEYM, phone numbers where parent/guardian can be reached for permission for emergency medical treatment/admittance:
Phone (days)*
Phone (evenings)*
Additional phone numbers
If parent/guardian cannot be reached, notify:
Days Evenings
Comments for Friends working with the children:
What is your preferred way to receive the LEYM Bulletin (newsletter)?
Via our current meeting distribution method Via e-mail Via US mail