Summer Camp '99 Registration Form

WAIVER & REGISTRATION FORM
PLEASE COPY THIS PAGE OR FILL OUT A SEPARATE FORM FOR EACH ADULT ATTENDING.

I understand that Summer Camp will offer a large variety of activities that can be physically, mentally, or emotionally engaging. 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 '99 Staff permission to call an ambulance or physician. I release Summer Camp Staff and NFNC from all liability for any injury to me from my participation in any of the activities. This release also applies to the minors listed below for whom I am responsible.

Days and Rates
Please check the days you plan to attend:
Pay by June, July, Aug for the price listed.

*Complete Package:* Aug 10-22
	Tue 10^th-Sun 22^nd Both Weeks Before July 22: $399. July: $449. Aug: $499.	$____

- - OR - -

*Individual Days:* A 'day' runs from 7:30 PM to 7:30 PM.
Daily Rate paid in July: $65. Aug: $75.
	Tue 10^th-Wed 11^th Opening Presentation, Sharon Byrd	Rate: $_____ times Days: #_____ Total: $_____
	Wed 11^th-Fri 13^th Solidarity, Consensus, HAI part 1, 2 days
	Fri 13^th-Mon 16^th Naka-Ima Workshop, 3 days
	Mon 16^th-Tue 17^th Ice Cream/ Auction, George Lockwood Workshop
	Tue 17^th-Fri 20^th Fishbowls, Radical Honesty, Community
	Fri 20^th-Sat 21^st Forum, Give-back Project, this day only: $15

Participant's Signature (if at least 18 years old):

___________________________________     __________
Name:                                                                Date
________________________________________________
Address:
________________________________________________
Cty, St, Zp:
________________________________________________

Home Tel. (_____) - ______________________________

Email: __________________________________________
Emergency Contact and phone:

___________________________ (_____) ____________
Minors' Names:
_______________________________ DoB: ___________

_______________________________          ___________

_______________________________          ___________
Parent/Guardian
Signature: _________________________      ___________
How did you hear about SC'99?                           Date
________________________________________________

Please Mail Check with this Registration Form to
SC'99, PO Box 160,
Forest Grove, OR 97116

A confirmation packet with your receipt, a map with directions, and last minute news will be mailed to all registrants. Some shuttle service from PDX to the Hood River camp site will be arranged. The confirmation packet will contain our shuttle schedule and contact info, along with Camp phone numbers for emergency use. The packets will be mailed around August 1st.	Your registration $________ Less discounts: $ -_______ Children 4-17: #____ at $15/day or variable scale 125-200 by age: $________
	Total Due: $________