Retreat Sign Up

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Your Name* This field is required.
First Name
Last Name
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Pronouns
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Your Student Email* This field is required.Retreat for College Students Only
example@example.com
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Your Phone Number* This field is required.
Please enter a valid phone number.
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Retreat ExperienceStay Weekend Leave Coffman on Fri 5:00 PM - Arrive at Coffman Sun Noon Come Saturday Leave Coffman on Sat 7:15 AM - Arrive at Coffman 8:30 PM
Stay Weekend
Come Saturday
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Dorm PreferencesCheck All That Apply - Let us know if you're comfortable sharing a room with men, women, or all genders. Your gender identity is honored here. You can also request an individual room. Email neontogether@gmail.com if you have any questions.
All Gender Dorm
Women's Dorm
Individual Room (Limited)
Men's Dorm
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Emergency Contact Name* This field is required.Please provide the name of someone we can contact in case of an emergency.
First Name
Last Name
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Emergency Contact Relationship* This field is required.My mother, father, parent, guardian, partner, friend, roommate, etc.
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Emergency Contact Phone Number* This field is required.
Please enter a valid phone number.
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Emergency InformationIs there any information you'd like to provide us in case of emergency? For example, any serious medical conditions that you'd like emergency personnel to know in case of a medical emergency (Serious drug allergies, certain medications, epilepsy, etc.)
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Dietary RestrictionsList any dietary restrictions we should know about.
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SignatureI understand that participation in this trip is voluntary and that such participation involves some element of risk. I agree that, in consideration of Neon (Wesley Foundation of the University of Minnesota) organizing this trip and permitting me, the student, to participate, I (including my parents, guardians, and legal representatives) shall not attempt to hold Neon (Wesley Foundation of the University of Minnesota), its trustees, officers, employees, faculty, agents, and co-sponsoring institutions and their agent(s) liable for any injury, death, or loss to person or property sustained by me while participating in or arising out of any travel or activity conducted by or under the auspices of Neon (Wesley Foundation at the University of Minnesota.) I agree to conduct myself in a safe and prudent manner while participating in any activity or travel conducted by or under the auspices of Neon (Wesley Foundation at the University of Minnesota). I understand that while participating in any such activity or travel, I am subject to the university's rules and regulations, including the following regarding health insurance. ‘’All students who are 1) admitted to a degree program, and 2) registered for six or more credits per semester (or three or more credits during summer term) that count towards the automatic assessment of the Student Services Fee, are required by the University of Minnesota to have health insurance." I give permission to use contact information provided to communicate with you and with your emergency contact. I hereby grant Neon (Wesley Foundation of the University of Minnesota) permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications. I authorize Neon (Wesley Foundation of the University of Minnesota) to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. While participating in this trip, I agree not to possess or consume any alcohol or drugs that are not prescribed to me. I understand that violating this agreement will result in me being sent home at my own expense. I also agree to conduct myself in a responsible manner, following all guidelines and instructions given by Neon (Wesley Foundation of the University of Minnesota) staff, board members, volunteers and by staff at the trip location. I agree to treat others with respect and kindness.
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