Application for Spring Youth Camp at Quaker Oaks Farm, April 15-19, 2019

We only have room for 30 campers, so we urge you to apply before the deadline. There is a question on this form where we ask you to tell us why we should select your application and what is important to you about getting to be a part of camp.

We will send out full enrollment forms and more details as we get closer to the date of camp.
**All campers must bring all permission and health forms with parent or guardian's signature to camp on the first day or mail ahead of time.**

More Camp Info at our Web Page:

Melissa Lovett-Adair (805) 305-9011 / / Co-Director
Darlene Franco (559) 731-1519 / / Co-Director
Alyssa Nelson (530) 563-6369 / / PYM Youth Programs Coordinator

Camper Info
Please fill out one form for each camper
Youth FIRST Name: *
Your answer
Youth LAST Name: *
Your answer
Youth E-mail:
If any. (Later in this form we ask for parent's email.)
Your answer
Youth Cell Phone: *
Like this: xxx-xxx-xxxx. If none, write "none." (Later we ask for parent/home phone.)
Your answer
Address Line 1: *
Your answer
City: *
Your answer
State: *
(e.g., CA)
Your answer
ZIP Code: *
Your answer
Date of Birth: *
Double check your entry so the form doesn't automatically put this current year!
Age at Camp: *
How old will the camper be on the last day of camp?
Your answer
Grade: *
or school level
Your answer
Your answer
T-Shirt Size: *
Think 'Unisex Adult Sizes'
Tribe or Indigenous Group:
(if any)
Your answer
Quaker Meeting Affiliation:
(if any)
Your answer
Other Affiliation:
e.g., Visalia UUs, FAIHP
Your answer
Please list names of any family members applying to camp, or working on staff or as a volunteer, and relation to camper (for example, Cindy Lou Who, sister):
Your answer
Essay Question: *
Youth: We only have room for 30 campers. Please tell us why we should select your application. What is important to you about getting to be a part of this camp? (A few sentences or a paragraph.)
Your answer
How did you hear about camp? *
Please check all that apply
Camper's Diet:
There is room in the next question to add details and anything not represented in this list
Eats everything
No meat for Lent
Prefers meat at most meals
No milk products
No egg
No soy
Other food comments:
Please be specific, especially about any allergies, intolerances, or ethical concerns. We'll pass on your questions/comments to the food coordinators, and we'll contact you if they need more info. We will do our best to accommodate each camper's needs, but we cannot guarantee no cross-contamination or unintended errors. (In extreme circumstances, such as if camper has multiple, complex, and/or severe food needs, please contact Melissa Lovett-Adair at A.S.A.P. so that we can help figure out how best to accommodate them.)
Your answer
Camper's Health
Please list any Allergies or other Health or Social-Behavioral-Emotional Concerns that we should know about ahead of time. Please feel free to contact Darlene Franco and/or Melissa Lovett-Adair directly if you prefer not to include it here (contact info above). There will be a question about this on the medical and permission forms that we will send you later, but we would appreciate knowing any important information now so we can be prepared. Thank you.
Your answer
Parent/Guardian Info
Parent/Guardian#1 NAME: *
Your answer
Parent/Guardian#1 PHONE: *
Like this: xxx-xxx-xxxx
Your answer
Phone type? *
Parent/Guardian#1 E-MAIL: *
If any (if you don't have email, please write 'no email')
Your answer
Parent/Guardian#2 NAME:
Your answer
Parent/Guardian#2 PHONE:
Like this: xxx-xxx-xxxx
Your answer
Phone type?
Parent/Guardian#2 E-MAIL:
If any (if you don't have email, please write 'no email')
Your answer
Payment Info
We ask for a deposit of $50 or payment in full (or a waiver request below) to hold your spot.
(Deposit is refundable, though intended to indicate serious intent to come.)

COST: No one will be turned away for lack of funds. Cost of camp is on a sliding scale ($0 - $500) and includes food, lodging, materials, staff support, and transportation during camp.
Any amount greater than $500 per camper is tax-deductible.

Payment can be made here:
(Please note "Spring Camp Payment for [Camper's Name]" in the "Tribute" section of the donation form.)


Alternatively, you can mail a check to:
Spring Youth Camp, Quaker Oaks Farm
17216 Avenue 296
Visalia, CA 93292
* Make check out to "Quaker Oaks Farm" with memo: Camper's Name and "Spring Camp."

We try to keep camp affordable thanks to volunteer contributions and other donations. We understand that some participants will have more travel costs than others. Please give as generously as you can to support the costs of camp, camper financial aid, and the work of Quaker Oaks Farm. Consider asking your Tribe, Friends Meeting, family, friends, or church or other organization if they can donate or contribute to your costs.

Thank you!

Deposit or Waiver? *
How much total do you intend to pay (including deposit)? Sliding scale $0 - $500. All campers are welcome regardless of individual ability to pay. Any amount greater than $500 per camper is tax-deductible. Write 'not sure yet' if unsure.
Your answer
Any questions?
or comments
Your answer
Thank you!
To finish, be sure to click "Submit" below. You can edit your application after you submit, if necessary.
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