Camp Mabon
Application to Attend Camp Mabon 2025
Friday, September 26 to Sunday, September 28, 2025
Sign in to Google to save your progress. Learn more
Email *
APPLICATION CRITERIA FOR CAMP MABON:

I am a cisgender woman 18+ years of age who identifies as a survivor of sexual violence, which may include sexual trauma involving a spouse or an intimate partner.
 *
Required
If you do not meet the criteria and would like to add explanation, please do so below.
CONTACT INFORMATION:

First Name/Last Name/Preferred Nickname:
 *
CONTACT INFORMATION:

Date of birth (month/day/year):
 *
Please provide your most active phone number: *
May we leave a voicemail message at this phone number? *
Required
May we leave a text message at this phone number? *
Required
Please provide your main e-mail address: *
May we email you? (only emails about attendance and camp details will be sent) *
Required
Your Address (including street, town, state and zip code): *
GENERAL INFORMATION:

How did you hear about Camp Mabon? (friend, agency, therapist, flier, ad, social media)
 *
If you attended Camp Mabon or Ostara in the past, in which year(s)?
Why do you want to attend Camp Mabon? *
TRANSPORTATION:

Camp Mabon 2025 will be held at Douthat State Park in Millboro, Virginia.
If accepted, could you provide your own transportation to and from Camp Mabon?
 *
Required
If you have transportation, are you willing to drive others from your area to and from Camp Mabon (if needed)? *
Required
If you cannot drive to Camp Mabon, could you get yourself to a meeting place to carpool with other participants from your area? *
Required
Camp ends by 5 pm on Sunday evening.  You have the option to stay for free Sunday night and depart Monday morning.  Would you like to stay over Sunday night? *
Required
PHYSICAL ACCOMODATIONS:

Do you need any physical accommodations made on your behalf (for example, difficulty standing or walking for more than 30 minutes at a time, inflexibility, temporary injuries, insomnia, sleepwalking, or sleep apnea) or other conditions that can hinder your physical range of motion? If so, please describe what physical accommodations you may need. Or enter none if you have no need for physical accommodations.
 *
PHYSICAL ACCOMODATIONS:

Please list any dietary needs you have (for example, gluten-free, dairy intolerance, vegan, vegetarian, specific food allergies). Or enter none if you have no dietary needs.
 *
PHYSICAL ACCOMODATIONS:

Is there anything else we need to know about your specific needs or capabilities?  Activities include short, gentle hikes, sitting, gentle yoga exercises, simple crafts, meal preparation.  If so, please list them here. Or enter none if their are no specific needs.
 *
PHYSICAL ACCOMODATIONS:

Please list any allergies you may have, eg. to plants, animals, insects, perfumes, etc.  Or enter none if you have no allergies.
 *
EMERGENCY CONTACTS:

If accepted to Camp Mabon, we need someone to contact in case any unexpected emergency happens - which is highly unlikely.  Please provide the following information for your emergency contact person.

Name, relationship to you, active phone number, email address.
 *
EMERGENCY CONTACTS:

Is is safe to contact this person in case of an emergency?
 *
Required
EMERGENCY CONTACTS:

If you answered "Not always" can you explain when this person can be contacted?
EMERGENCY CONTACTS:

If you answered "No" can you suggest an alternative before camp begins who might fulfill this role (agency, counselor, cleric)?
AGREEMENTS IF YOU ARE ACCEPTED TO CAMP MABON:

To begin our program on time, all campers need to arrive between 1:00 pm and NO LATER than 2:00 pm on Friday.  Please indicate that you understand this and are making a commitment to arrive on time.
 *
Required
AGREEMENTS IF YOU ARE ACCEPTED TO CAMP MABON:

To support recovery, Camp Mabon is a drug and alcohol-free program.  Please indicate that you understand and will not bring drugs or alcohol to Camp Mabon.
 *
Required
AGREEMENTS IF YOU ARE ACCEPTED TO CAMP MABON:

Camp Mabon is a firearm/weapon-free environment.  Please indicate that, even if you have a concealed carry permit, you will not bring your concealed weapon to Camp Mabon.
 *
Required
AGREEMENTS IF YOU ARE ACCEPTED TO CAMP MABON:

Camp Mabon is not a clinically therapeutic environment, and therefore, individuals who are actively suicidal are not appropriate participants for camp.  By checking below, I certify that I will not attend camp if I am actively suicidal.
 *
Required
FOR CAMPER SAFETY AND PLANNING:

What should we know about any concerns related to your safety or others' safety while you're at the camp? (For example, active protective orders, stalking, threats, ongoing court cases, custody issues?)  Enter none if this does not apply.
 *
IF YOU HAVE ATTENDED CAMP OSTARA OR CAMP MABON AT LEAST ONCE IN THE PAST:

Would you like to be considered to serve as a Mentor, helping new campers get settled in, encouraging campers to participate in activities, and taking a leadership role in your tribe.  You may be asked to provide carpooling from your area if needed?
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms