Peace camp sample application
South Bay Youth 4 Peace Summer Camp 2010 Application
Name: Age:
Street Address:
City, State, zip
Email:
Telephone: Cell Phone:
Organization/Group Affiliation (if applicable):
School/University (if applicable):
How do you describe yourself? (Whatever you want to share— favorite subject in school, your
best summer, a role model, what you like most about your best friend, best local band, etc.)
Please list 2 people who know your interest in peace and justice and their phone numbers:
1.
2.
Please answer these questions briefly:
Why do you want to attend Peace Camp?
What issues are most important to you?
(Check three)
__military recruitment on campus __immigrant justice
__stopping war __students’ rights
__protecting the environment __economic justice (poverty)
__gay rights __animal rights
__women's rights __resisting corporate domination
__ending racism __organizing peace clubs
__health care __public education / privatization
__self-expression (creative, political) __other (explain)
What do you hope to learn from the camp?
What experience have you had with community organizing or social justice groups?
How did you hear about the camp?
If you are a returning camper (Peace Camp 2005-2009), what peace/justice activities at school have you been involved with in the past year?
What are your concerns, if any, about being at camp?
Some important things we need to know:
What are your dietary restrictions, if any?
Do you have any allergies, medical conditions or disabilities we should know about?
Do you have any other specific needs?
Do you need assistance raising funds for camp tuition?
Permission to attend the SBY4P Summer Camp. (must be signed by parent or guardian for any camper under 18 at time of application.
My child, ______________________________________has permission to attend the South Bay Youth 4 Peace Summer Camp at Circle X Campground. I have read the medical release form, and am aware of the Code of Ethics for Youth.
Parent/ Guardian Signature:
________________________________________________________
Date: _______________________________
Please return application form, medical release form and code of ethics, along with a check
for $150.00 made out to S.P. Neighbors for Peace & Justice, by June 15th, 2010. Send to
SPNPJ, P.O. Box 804, SP 90733. South Bay Youth 4 Peace offers fundraising opportunities
if you are unable to afford camp tuition. Scholarships are also available on a limited basis.
Please fill out the application form and send to be eligible for these options.
Youth Signature __________________________ Date_________________