Power of Hope

REGISTRATION FORM

Power of Hope - Whidbey

July 28 - August 4, 2019


If you have any problems in submitting this form, please contact susan@partnersforyouth.org.


Contact information



Gender Identity
At POH Camp, we acknowledge that gender identity is personal and not simply confined to a binary. Since it's not possible to know without asking, what pronouns would you like us to use for you at camp?

For more info on understanding gender, we recommend checking out the Gender Spectrum website - https://www.genderspectrum.org/quick-links/understanding-gender/








Note: We request ethnicity/race information for the purposes of understanding our population better and fulfilling grant reporting requirements.

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




Emergency Contact Information

Name of person youth lives with:






Second person youth lives with (where applicable):






Emergency contact in case parents or guardians cannot be reached:




Second Emergency Contact (where applicable)




Language

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 - susan@partnersforyouth.org. 






Dietary Needs




Medical/Health Information





























Transportation Information
You are responsible for your transportation to and from camp. If you would like a ride from Seattle to camp, you can sign up to take the POH bus from the Garfield Community Center 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.

Swimming


Camping

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




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.


Registration Fees
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 that is supported by fundraising and grants. Please choose the level of participation that fits best with your financial situation. Our goal is to turn no one away due to inability to pay.
  • Scholarship: $100-$600 - Supported by annual fundraising and grants
  • Tier 1: $695 - Covers a portion of the program expenses, supplemented by significant annual fundraising and grants
  • Tier 2: $1000 - Covers a substantial portion of the cost of having a young person attend the camp
  • Tier 3: $1200 - Covers the true cost of having a young person attend the camp
  • Tier 4: $1550 - Covers the true cost of having a child attend the camp AND scholarships half the tuition for another participant in need

Scholarships are awarded on an individual basis. We will contact you soon to confirm your award.
Payment
A $200 deposit is required with your registration in order to hold your space at camp. Any outstanding fees will be due on June 30. You are also welcome to pay in full at this time. 




This is a calculation of the registration and transportation fees due today.
Pay by Credit Card
Once you have submitted this form you will be taken to PayPal where you can pay with a credit card.
Pay by Check

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

PYE/POH 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.

After submitting this application, return to the Power of Hope website to download the required Medical Release and Hold Harmless forms.
HIDDEN


Demographics
We require the following information for the purposes of 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.