PYE/Power of Hope Camp Registration Form

Power of Hope Whidbey: July 28 - August 4, 2019

If you have any problems in submitting this form, please contact

Participant’s Consent to Basic Guidelines
The following non-negotiable guidelines have been established for participants of the PYE/Power of Hope camp in order to create a safe and respectful environment for everyone.
  • Remain in the program grounds at all times unless you have authorization to leave
  • Check-in all valuables including money, electronic equipment, passports, etc with the camp manager for safekeeping at registration
  • Refrain from coupling/sex
  • Refrain from using drugs or alcohol
  • Avoid violence 

Please note ** Do not bring cell phones, i-Pods, CD players, head sets or other electronics. If you forget and bring them or need them for your travel to and from camp, we ask that you check them in with the camp manager at registration (along with other valuables). We'll put them in a locked area for safe keeping during camp. If you don't check in your valuables and something goes missing at the camp we will assume you have misplaced it. We will not assume it was taken by someone else. Please help us keep the positive energy going at camp by checking in your valuables. PYE/Power of Hope cannot be responsible if they are lost.

Contact information

Please Note: Participants must be 14 years old on or before the first day of camp.


We require the following information for the purposes of helping our staff use the most respectful language when addressing you, understanding our population better, and fulfilling our grant reporting requirements. Please help us serve you better by selecting the best answers to these questons. Thank you.

Emergency Contact Information

Name of person/people youth lives with:

Person 2 (where applicable)

Name of emergency contact in case parents or guardians cannot be reached:

Person 2 (where applicable)


Power of Hope strives to provide a inclusive environment for all youth including those whose first language is not English. To help us meet this goal, please let us know your language abilities and needs. If you have any concerns about language at camp, please contact Susan Janow - 

Dietary Needs

Medical History

Transportation Information

If there is enough demand we will run a camp run bus from Seattle to Whidbey Island. Round-trip cost $40.

In order to assist all participants in arranging their transportation we need your permission to share your contact information with other participants. Notice: You, the participant are responsible for figuring out how you are going to get to the event.



This is an outdoor, residential camp. If you do not have your own equipment, we do have items that you may borrow. 

Financial Information and Worksheet for All Participants
In the effort to support our mission of offering a transformative camp experience to any young person who wants to come, we have a tiered pay scale for the program costs. Please choose the level of participation that fits best with your financial situation.

Tier One: $695
Covers a portion of the program expenses, supplemented by significant annual fundraising and grants
Tier Two: $1000
Covers a substantial portion of the cost of having a young person attend the camp
Tier Three: $1200
Covers the true cost of having a young person attend the camp
Tier Four: $1550
Covers the true cost of having a child attend the camp AND scholarships half the tuition for another participant in need

*If you are unable to cover the cost for Tier 1, please contact the office (360-221-5713) for a confidential scholarship conversation. Our goal is to turn no one away due to inability to pay.

Payment Schedule

A $200 deposit is required with the registration in order to hold your space, unless applying for scholarship. This can be paid now, via credit card, or by sending a check made to PYE, PO Box 1481, Langley, WA 98260. 

The remaining balance is due June 30.

After submitting your application, return to the Power of Hope website to complete step 2.

Once you have submitted this form you will be taken to PayPal where you can choose to pay by credit card.

Please make the checks out to PYE and write the participant's name on the note line of the check. Mail to PYE, PO Box 1481, Langley, WA, 98260-1481. 

Please mail your $200 deposit as soon as possible after submitting this application.

PYE Privacy Policy
The personal information collected here is kept confidential and used only in the registration process through the duration of the Power of Hope camp that you have registered for. Your contact information will be stored indefinitely in our registration system as part of your transcript with Power of Hope/Partners for Youth Empowerment. For complete details on PYE's Privacy Policy, visit the website.