Registration

Talk Story Camp Registration Form

July 19 – 21, 2013 CANCELLED

http://talkstorycamp.com/

 THIS FORM IS NO LONGER NECESSARY SINCE

ACTIVITIES HAVE CHANGED.

WE ARE NO LONGER DOING A CAMP RETREAT.

HERE IS THE EXISTING NON-CAMP SCHEDULE

Adult Participant(s) (aka The Ringleaders)NONE 

Name(s)       _________________________________________        _____________________________________

Home Phone(s)       ___________________________________        _____________________________________

Work Phone(s)      ____________________________________        _____________________________________

Cell Phone(s)       _____________________________________        ____________________________________

Email Address(s)      __________________________________        _____________________________________

(You will receive an email confirming registration, updates, gate combination, etc.)

 

Emergency Contact NONE

Name:      ___________________________________________

Relationship:     ______________________________________

Home Phone    ________________    Work Phone     ________________    Cell Phone    ________________

Email Address      ____________________________________

 

All Participants

(Please use additional forms as necessary and attach.)

FULL CAMP

Includes Activities Friday-Sunday, 5 Meals (Sat. Breakfast to Sun. Lunch)

Lodging (circle one):               Long House              Will bring own tent

Adult(s)                 Listed Above                                                                      _____  X $60 ____________

Additional Adult(s) _________________________________________________    _____  X $60 ____________

Child(ren) 10-18 ($35 for 1st child, $25 for each additional child):

                        Name                                                           Age             Number                    Total

_____________________________________           Age       ________          _____  X $35     ____________

_____________________________________           Age       ________          _____  X $25     ____________

_____________________________________           Age       ________          _____  X $25     ____________

Child(ren) under 10 ($20 for all):

                        Name                                                           Age             Number                    Total

_____________________________________           Age       ________          _____  X $20     ____________

_____________________________________           Age       ________          _____  X $20     ____________

_____________________________________           Age       ________          _____  X $20     ____________

                                                                                                 Discounts (see below)   –  ____________                                                        

                                                      (Please see Payment Instructions below.)       Total   ____________


ON-SITE REGISTRATION
: NONE

We’ll add $5/per person. (Eh! We gotta scramble fo get da food for you! So send in registration now!)

 

DAY CAMP (with Activities & Meals): NONE

 (Please circle one or both)

Saturday- Breakfast, Lunch & Dinner              Sunday- Breakfast & Lunch

Adult(s)                 Listed Above                                                                      _____  X $35 ____________

Additional Adult(s) __________________________ _________   ____________    _____  X $35 ____________

Child(ren) 1-18

                        Name                                                           Age             Number                    Total

_____________________________________           Age       ________          _____  X $20     ____________

_____________________________________           Age       ________          _____  X $20     ____________

_____________________________________           Age       ________          _____  X $20     ____________

 

DAY CAMP (Activities Only)

Saturday                 Sunday    

Adult(s)                 Listed Above                                                                      _____  X $25 ____________

Additional Adult(s) _________________________________________________    _____  X $25 ____________


Child(ren) 0-9                                                                                                                             

                        Name                                                           Age             Number                    Total

_____________________________________           Age       ________          _____  X $10     ____________

_____________________________________           Age       ________          _____  X $10     ____________


Child(ren) 10-18

                         Name                                                           Age             Number                    Total

_____________________________________           Age       ________          _____  X $15     ____________

_____________________________________           Age       ________          _____  X $15     ____________

                                                                                                 Discounts (see below)   –  ____________                                                        

                                                      (Please see Payment Instructions below.)       Total   ____________

 

Discounts:

No discounts if you miss a meal. (These are really reasonable rates, after all!)

College Students: Active college students (with ID), note $5 on the discount line.

(Please designate student receiving discount with an asterisk (*) before their name(s) on the registration form above.)

 

Payment Instructions: NEVER MIND

Please complete and print this Registration Form. (Retain a copy of all pages for your records and reference.) Mail the form with your check made out to Alliance for Culture and Arts to:

 

Alliance for Culture and Arts

PO Box 37495

Honolulu, HI  96837

 

Dietary Restrictions:

Vegetarian: Put a “(V)” before applicable names above.

Other: Explain dietary needs here.                                                                                                                        

____________________________________________________________________________________________

____________________________________________________________________________________________

 ____________________________________________________________________________________________

Please share any noteworthy physical disabilities (wheel chair, cane, etc.) so the Talk Story Camp staff can anticipate, accommodate & include you. (Kualoa Camp is an accessible facility with concrete pathways throughout the camp area, including a path to the edge of the beach.)

                                                                                                        

Your Story:

If you wish, please include a bio, resume, or even just a sentence introducing us to your life/activities. We’d like to know a little about who you are, who’ll be coming to camp, why you’re joining us, what you do in life!

                                               

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