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QUEER CAMP 2015 Camper Registration!
Do you want to Sign-up for QUEER CAMP 2015? Please fill out this form to reserve your spot, space is limited!
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Name
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Birthday
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YYYY
Gender Pronoun
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School or Organization you're affiliated with?
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T-shirt size?
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Phone Number
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E-mail
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Address
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Any Allergies?
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Any Medications you currently take?
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Any relevant phobias you may have?
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Any health concerns?
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Do You have Tents, sleeping bags, camping equipment? Please specify;
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Anything else you'd like the QUEER CAMP 2015 Organizers to know?
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Parent/ Guardian Name
*
Your answer
Parent/ Guardian Phone
*
Your answer
Parent/ Guardian E-mail
*
Your answer
Parents/ Guardians, Are you able to provide Transportation to;
Your own youth
Your own youth AND other youth who need rides
I cannot provide transportation, my youth need to carpool with others
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We are asking a "suggested donation" of $125 for Queer Camp registration to cover the costs of Queer Camp. Checks can be made out to The Diversity Center and mailed to P.O. Box 8280, Santa Cruz, CA 95061
That being said, NO ONE will be turned away for lack of funds.
Yes, I can make a donation of $125
Yes, I can make a donation of $125 and also sponsor one or more youth
No, I cannot make a donation of $125 but I can donate something
No, I cannot make a donation at this time
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