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NFNC Summer Camp 2017
WAITLIST Form


We consider camp a growthful co-creation of all who show up. We limit the size
of camp to enhance community connection. For this reason we are continuing to experiment
with our application process. We appreciate your participation and patience.

We believe that cultures tend to thrive best with a wide spectrum of differences; so does our
summer camp. We are asking some questions to help us in the process of creating a diverse
and dynamic camp. These are some criteria we've found help us fulfill this intention.

A wide spectrum of the following:
mix of new campers vs. returning campers
gender ratios (male-identified, female-identified, Other-identified),
sexual orientation (LGBTQ+), families, class, race/ethnicity, age, cultural origins
In the comment box at the bottom of this form please let us know
anything about yourself in regards to creating a diverse environment.

Please note that this event is not a first-come, first-serve ticket purchase or festival. If
you've been accepted and have found you cannot attend, please contact us as soon as possible.
You cannot sell your spot.

We are actively seeking property to be used for Summer Camp and
year-round community events. If you are interested in contributing a tax-deductible
gift please send a separate check made out to New Culture Institute and mail to New
Culture Institute, PO Box 50388 Eugene, OR 97405. Thank you for your kind support.

(fields marked * are required)

15 Day Summer Camp - July 28 - August 13

Camp
Select one:
First Week Only: Sliding Scale $600 ($400) - $1000
Second Week Only: Sliding scale $525 ($400) - $1000
BOTH Weeks: Sliding scale $1,000 ($750) - $1,500
            ($$$) for 18-32 year old campers 		Amount *
$ 

If applying for a scholarship, choose which week(s) you want to attend and fill in the amount you can pay. Additionally, send an email asking about scholarships to scholarship@nfnc.org with "SC Scholarships" in the subject header. Also, use the Comment field at the bottom of this form to tell us a bit about yourself and your need.

Note: if you qualify and are applying for the second week only, we still have several slots available; you'll not be put on the waiting list at this time, but rather moved directly into consideration for camp.

Tax Deductible Contributions

To make tax deductible contributions to camp, click here.

Waiver Release Form

Please note that you must sign the following waiver release form
when you first arrive on site, before you will be admitted to camp:

“I understand that Summer Camp will offer a variety of activities that can be physically, mentally, and emotionally challenging. The level of my participation in any of the activities is at all times completely my choice. I may stop or say “no” at any time. In the event of an emergency, I give the Summer Camp 2017 staff permission to call an ambulance or physician. I release the Summer Camp staff, NFNC, and NCI from all liability for any injury to me resulting from my participation. This release also applies to the minors listed on this registration form for whom I am responsible.”

ATTENTION

*** Note: You must fill out a separate registration form for each adult who
wants to attend camp. Please comment if you are a part of a family unit.


Name and Address
Name *
Address *
City *
State/Prov. (2char) *
ZIP/Postal Code *

Contact Info
Home Phone (please enter at least
Mobile Phone one phone number) *
Email *
Emergency Contact Name *
Emergency Contact Phone *
Your Date of Birth * / /

We provide Internet at Camp. However, we pay by bandwidth used. Please support your expected use.
I will be using the Internet to do work while at camp. Contribution: $10-$100.
Please include this in your camp fee.
Allergies & Food Preferences
No Eggs No Dairy No Gluten/Wheat No Peanuts No Soy
Allergies / Comments

We’ll do our best to accommodate you.


Children

Children under 12 (accompanied by an adult) are welcome at camp for free.
Children 12 to 18 (accompanied by an adult) are $150 per week.

Full Name of Child I’m Bringing Date of Birth
1 //
(more lines will open as you add children)

Staying in Touch
I want to subscribe to the 2017 Camper eList to meet campers,
arrange rides, and get news before camp starts:
yes

We’ll create a photo contact sheet that will later be sent to all 2017 summer campers. Please checkmark any items you DO NOT WANT to appear on the contact sheet.

Do not include:
My Photo My Name My Address My Email My Phone


Helping Create Camp
I'm available to help CREATE our camp venue at our 300 acre location north of Grants Pass.
We'll be making weekend outings to the site to do substantial improvements, upgrading the lodge, adding a wheelchair ramp, preparing camp sites.
May June July

We’ll feed you and love you.



Helping Close Camp
I'm available to help take down camp after it ends:
Monday, August 13th Tuesday, August 14th Wednesday, August 15th

We’ll feed you and love you.



Comments, Questions and Concerns
Tell us about yourself!   Anything else?   Coming with someone?

By submitting your application you agree to pay the full camp fee listed on your application if accepted to camp.

Submitting your application does not guarantee that you will be attending Summer Camp West.

You will receive notification about your acceptance to camp by May 17th. After receiving this notice you will have two weeks to send in your payment via PayPal or Check. If you do not submit your payment by the two week deadline your place at camp will be given to a camper on the waitlist. You will be emailed a packet with detailed camp information in early July, with a map, directions, and other important information.

You can't register after Camp is over!


Nearest Airport is in Medford, OR. (just under an hour drive away)

Questions? Contact sc17w@nfnc.org