Summer Camp 2024

Madrona Folk School Summer Camp with Salila and Madi Registration Form 2024

June 18-20, 2024 : Tues, Wed & Thurs 10-3 Ages 6-8 (turning 6 by September 1st 2024) Please fill out a separate form for each youth. $90-120 sliding scale
Please select all camps that your child will be attending.*

Camp (June 18-20)
Youth's Name*

First NameLast Name
Parent's or Guardian's Name*

First NameLast Name
2nd Parent's or Guardian's Name

First NameLast Name
Youth's Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's email*
Second email
Only fill this out to receive all emails at 2 email addresses
Parent's cell - 1st Parent listed above*
Parent's cell - 2nd Parent listed above
Please share a little about your child's strengths and passions. What does he or she enjoy and what does he or she excel at?*
Does your child have any special needs that will be helpful for the teachers to know about? Please include IEP or 504 plans. *
Is your youth taking any medication (on the days that s(he) will be in our care)?*
Please include 2-3 emergency contacts that we can call upon if we can't reach you in the case of an emergency or early pick-up. *
Please include all adults who have permission to pick up your youth. You may add more at anytime. *
Permission to use photos. Do you agree for your youth’s image to be used on promotional materials which may be posted on social media, our website or other places? We will not identify a specific youth in a photo. If “no” we will blur out his or her face if in a posted group photo.*

YesNo
Legal Release Form's Intention - Madrona Folk School's summer camps are held at our private rural properties. Although the teachers and volunteers of Madrona Folk School will always prioritize safety and care for each youth in our charge — we cannot assume legal responsibility for any accidents or injuries that may occur in our care. There are numerous natural features, obstacles and unforeseen events that may cause injury and hardship to your child. Please knowingly and willingly assume full responsibility for your own child and make the decision to place him or her in our care with the intention NOT to sue us or to indemnify us in the case of harm. Legal Release Form I hereby voluntarily release, forever discharge the community (Madrona Folk School), the corporation, its officers, directors, employees, volunteer and agents from any and all claims, demands, or causes of action, which are connected with my child's participation in the programs or the use of the equipment and facilities. Please sign in the next field.
Signature*
Full payment is required to reserve your youth's spot in the Summer Camp(s).

Camp - $90 - 120 - sliding scale.

You may mail us a check made out to: Madrona Folk School.

Please mail your check to Madrona Folk School 507 Hidden Valley Road, Grants Pass OR 97527.

Or you can pay with cash by putting an envelop with cash payment in our mailbox. Please email us at dovekin42@gmail.com to let us know when you plan to drop it off so we can pick it up promptly.

Lastly you can pay with funds from Teach NW. For TNW we can send you an invoice that you can pay with your PEX card. Please email us to arrange this.

The summer camp will be supervised by adults (Dove or Stevie) as well as Salila and Madi.

We will have a short 15 minute parent orientation the first day of camp. We will send out a full welcome email with a list of items to bring and more details the week before camp begins.

Thank you for signing up! We look forward to welcoming your youth to our Summer Camps. Feel free to reach out with any questions. dovekin42@gmail.com

Warmly,

Madi and Salila
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Madrona Folk School Summer Camp with Salila and Madi Registration Form 2024