Yay! You’re coming! Please fill out neatly in ink or type. Return the original copy of this registration to Genius Tribe, P.O. Box 1014, Eugene, OR 97440. We cannot accept faxed registrations. Also, each camper must have his/her own registration form--do feel free to make photocopies; don't put siblings or friends on the same form. You must enclose a $75 NON-REFUNDABLE deposit with this registration, checks made out to Genius Tribe. We accept checks and money orders only; no credit cards; U.S. funds only. Your deposit will be refunded in the event that the camp is canceled or if the camp is full before you register, but not for any other reason including illness. The balance of your camp fee is due 6 weeks before the start of camp, and if all money is not in one month before the start of camp, you will be dropped from our roster. There are no refunds at all, of any amounts paid, after 6 weeks before the start of camp, so if you’re going to cancel your registration you’d best do it before then. If your registration is postmarked by March 18, 2000, your total cost is $450 (or more or less if you wish to participate in the sliding scale experiment, see below). If your registration is postmarked after March 18, your total cost is $475 (ditto). We will send an acknowledgement within a few weeks of receiving your registration, confirming which session you are registered for, how much money we have received, and how much money you will be paying total. If you don’t hear from us within a month, please contact us to make sure we got your registration. We suggest you make a copy of this form after filling it out.
Which session are you registering for? ____Session I (8/27-9/3) ____Session II (9/5-9/12) _____ Both sessions (You must send a $75 deposit for each session.)
If your first choice session is already full, would you like to register for the other session? _________
Your legal name (first/last): _______________________________________________________
Preferred name or nickname if different: _______________________
Daytime phone________________________
Complete mailing address with zip/postal code/country if not U.S.:
_________________________________________________________
______________________________________________________________________________________________________________
e-mail address:____________________________________
Parent/guardian name(s) (first/last) and address(es) if different from above:
__________________________________________________
___________________________________________________________________________________________________________
Name 2 other people to contact in case of emergency. (We will attempt to contact parents/guardians first unless you request otherwise. If unable to reach parents/guardians, we'll contact the first person listed below, and if we reach her/him, we won't contact anyone else unless you request that clearly in the space below.)
1st choice--name and relationship to you:________________________________________________________________
Daytime phone: _____________________________________
Evening phone:__________________________________
2nd choice--name and relationship to you: _______________________________________________________________
Daytime phone: _____________________________________
Evening phone:__________________________________
Your birthdate (month, day, year):__________________Your gender ___F ___M
Circle foods you do not eat (meat will probably not be served, and white sugar and caffeine are generally not served either).
dairy products (milk, cheese, butter etc.) eggs wheat
Do you have any medical conditions or physical limitations you'd like us to be aware of? (Note: You will also be required to fill out a medical history form, which you'll receive later. The information here will be shared with most of the staff; information on the medical history form will only be shared with staff if it seems necessary for campers' well-being.)
___________________________________________________________________________________________________________
What, if anything, would you like us to do to help you deal with this condition(s)?
___________________________________________________________________________________________________________
Can we share your data with other campers? In June 2000 we will send out a directory of campers to enable you to hook up with each other for travel arrangements. May we include your name, email address, phone number, and address on this list, and also in the directory which all campers receive at camp?
Money: Please read this section carefully. The actual cost of camp (including all overhead, labor, food, lodging, mailings, local transportation, supplies, etc.) is $450 per person. You may elect either to pay that amount or to participate in the sliding scale. However, we need to know now how much you will pay, and if you say you will pay more than $450, you cannot later change your mind, since we will have promised the extra amount to another family. Please check option #1, #2, or #3 below, and answer accompanying questions. (If you register after March 18, remember to add $25 to your total fee, which means it will range from $375 to $575.)
1) _____I will pay $450. OR It’s after March 18; I’ll pay $475. ________
2) _____My family can afford to pay more than $450/$475. (up to $550/575 suggested for families with financial abundance.) We will pay __________. We understand that our extra payment will be directly applied to the camp fee of a family who cannot afford the regular cost. (Please note: even if you later cancel your camp registration, we need you to honor this part of your agreement and still contribute the extra amount you’ve promised. We learned this the hard way in 1999, when one family volunteered extra money but then canceled and left the recipient of those funds stranded! Otherwise, our “sliding scale” experiment has worked beautifully.)
3) _____My family cannot afford to pay $450/$475. If another family contributes extra money, we request that their surplus be applied to our fees. We would like to pay (minimum $450/475) _________. I understand that the money resulting from other families’ contributions will be applied on a first-come first-serve basis. If there is no money available, and I need to pay the full amount ($450/$475), then I still want to register for camp and agree to pay $450/$475 if necessary: ______yes _____no
For people applying for half-scholarships and/or work trades—please answer this question carefully:
I will attend NBTSC whether or not I receive a scholarship/work trade: _____yes _____no
(If you check yes, we will guarantee you a spot at NBTSC but will NOT refund your deposit unless we give you a worktrade position. If you check no, we will refund your deposit if we can’t give you a worktrade position or scholarship, BUT we can’t necessarily guarantee you a spot at NBTSC.)
Note to everybody: In June we'll send you a handbook, a detailed questionnaire, and we’ll request that you send 2 photos and a description of yourself to help the staff get to know you a little bit before camp. We'll ask (among other things) what workshop, sport, or other activities you might be interested in leading or co-leading. You might want to start thinking about it now.
Here's the stuff you gotta sign:
I have read all of the accompanying information on Not Back to School Camp, and I am choosing to attend by my own free will. No parent, guardian, or other person is coercing me into attending. I certify that all of the information provided above is accurate and complete to the best of my knowledge. I agree to abide by the rules set by the camp staff, and to contribute to the camp by performing chores as needed and by sharing my unique skills and creativity. I understand that there will be no nurse or other medical personnel on the premises, but that if anyone has a serious medical emergency she or he will be sent via ambulance to a hospital. (Camp Myrtlewood provides insurance for injuries that take place on their premises.) I will be as responsible as possible for my own health and well-being, and notify staff immediately if I have a health or other problem which needs attention. I understand that if I violate camp rules repeatedly, or in any way that the staff considers seriously threatening to others' camp experiences, I will be sent home immediately at my own expense. I promise to do my best to have a great time and to help everyone else have a great time too. I also understand that my deposit is non-refundable if I later choose not to attend camp (unless camp is full before this registration is received), and that there will be absolutely no refunds for any reason of any camp fees after July 16 (1st session) or July 25 (2nd session) (unless camp is canceled). And, I understand that I cannot attend camp if I do not complete and return the required forms before the beginning of camp.
Signature __________________________________________ Date ___________
Parent/guardian statement (both parents sign if possible, please):
I have read all of the accompanying information on Not Back to School Camp. My son/daughter is attending camp by her/his own free will and is not being coerced into doing so by me. I certify that all of the information provided above is accurate and complete to the best of my knowledge. I understand that there will be no nurse or other medical personnel on the premises, but that if anyone has a serious medical emergency she or he will be sent via ambulance to a hospital. (Insurance is provided for injuries that take place on camp premises. I agree to be responsible for any emergency or medical expenses not covered by this insurance.) I understand that if my son/daughter violates camp rules repeatedly, or in any way that the staff considers seriously threatening to others' camp experiences, he/she will be sent home immediately and I will be billed for that expense.* I agree to reimburse Grace Llewellyn for any expenses incurred in such an event. I also understand that the deposit is non-refundable if my son/daughter does not attend camp (unless camp is full before this registration is received), and that there will be absolutely no refunds for any reason of any camp fees after July 16 (1st session) or July 25 (2nd session) (unless camp is canceled). And, I understand that my daughter/son cannot attend camp if she/he does not complete and return the required forms before the beginning of camp.
Signature __________________________________________ Date ___________
Signature __________________________________________ Date ___________