PolyCamp NE Registraton
Name *
Address *
City, State, Zip *
Phone Number *
XXX-XXX-XXXX
Email Address *
Add to secret Facebook group? (PolyCamp Northeast) *
Only members can find the group and see the posts.
Housing Preference *
Roommates Requested *
Please list all adults you would like to share housing with.
Special Housing Needs
only if you are requesting special accommodation
Food Allergies/ Restrictions *
Please do *not* list food preferences. This is only for allergies and significant dietary restrictions.
Community Service *
Everyone is expected to pitch in with cleaning their housing area and the general campgrounds before camp ends. Everyone also needs to take one shift of meal set up/ clean up/ dish duty. Please choose the meal you would prefer to help with.
Special Needs
Do you have any special needs or medical/psychological issues the organizers should know about? If so, please give details here. (This information will be kept confidential within the organizing team.)
What would you like to teach?
This event will be built by the people who attend - that means you! What skills or knowledge do you have to share? Can you lead a workshop or facilitate a discussion group? Can you lead a game or campfire sing-a-long? This does not necessarily have to be something related to polyamory.
What would you like to learn?
Are there any particular topics for a discussion or workshop that you are hoping will be offered?
Are you 18 or older? *
Future events may include programming for children and teens but this event is adults only.
Emergency Contact Name *
Please give us the name of a person to contact in case of emergency, preferably someone who is not also attending this event.
Emergency Contact's Relationship to You *
Does this person know the nature of the event you are attending? *
Emergency Contact Phone Number *
XXX-XXX-XXXX
Payment *
You may pay either by credit card or by sending us a check. Credit card payments will be taken through PayPal and a $6.85 per person processing fee will be added. Your registration is not complete until payment is received. If payments are bundled together, please clearly indicate who the payments are for. Further instructions will be given when you hit "Done."
How did you hear about PolyCamp? *
If referred by a friend, please list their name. If seen on Facebook, please let us know which group.
Additional Notes, Questions, Comments
Will you be arriving late or leaving early? Do you have special requests or suggestions? Feel free to share them here.
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