Online Application
WASHINGTON STATE YOUTH CONSERVATION CAMP
Camper's Name
Sex
Birth Date
Mailing Address
Number of Previous Years At This Camp
Age Just Prior To Camp
State
Zip
City
Name of Parent/Guardian
Work
Phone
Home
Phone
Cell Phone Numbers
Email Address
Sponsor (if other than parent/guardian
Sponsor Mailing Address
Zip
State
City
Contact Person
Sponsor Phone
Who will deliver the camper to the ferry dock?
Who will retrieve the camper at the end of the week?
(If other than parent/guardian, a signed letter of permission is
required)
Who has legal custody of the camper?
Is there anyone specific the camper should NOT be released to?
Emergency Contact
Emergency Contact Phone
N
Y
Has this chold been away from family for a full week before?
Do you believe he may have difficulty adjusting to a structured
camping situation?
(If yes, please send an explanation via email to
lonnie_mccann@yahoo.com ).
Signature of Parent/Guardian
Signature of Camper
Date
By submitting this application electronically I understand that
I still need to either mail in, email a copy of, or bring to the
dock with my camper, a SIGNED MEDICAL RELEASE FORM.
I can find a form for downloading on the "Forms" page of this
website.
Transportation to and from Anacortes will be the responsibility of the sponsor/parent/guardian. If car pools are
desired, phone numbers of other campers in your area can be obtained from your camp directors. To be fully
completed, this application must include (1) the signatures of the camper and the parent/guardian at the bottom of
this page, and (2) the full camp fee of $300.00. If, due to some emergency, a camper is unable to attend, the
sponsoring club or organization (if any) and the Camp Directors must be notified immediately so that a
replacement can be located. NO REFUNDS WILL BE MADE FOR NO-SHOWS AT THE FERRY DOCK. There will be
no discrimination due to race, color, religion, or nationality.


THIS APPLICATION AND THE INFORMATION CONTAINED HEREIN ARE TRUE AND ACCURATE TO THE BEST OF
MY KNOWLEDGE. SIGNATURES BELOW INDICATE THAT THE CAMPER HAS PARENT/GUARDIAN PERMISSION
TO ATTEND CONSERVATION CAMP ON ORCAS ISLAND, AND THAT THE CAMPER AND PARENT/GUARDIAN
HAVE READ, UNDERSTOOD, AND AGREED TO ABIDE BY THE CAMP POLICIES. IT IS FURTHER AGREED THAT,
SHOULD THE CAMP DIRECTORS FEEL THAT CONTINUED INFRACTIONS OF CAMP POLICY OR
INAPPROPRIATE BEHAVIOR OF A CAMPER CONSTITUTE A THREAT TO THE HEALTH, SAFETY, OR SECURITY
OF THE CAMPER OR OTHERS, THE PARENT/GUARDIAN OF THE CAMPER INVOLVED WILL BE EXPECTED TO
COME TO ORCAS ISLAND TO RETRIEVE THE CAMPER. BY SIGNING, YOU ARE AGREEING THAT YOU ARE THE
PERSON STATED.
Here is the PayPal button. If you'd
like to pay online instead of mailing a
check in, just enter your purchase,
click it, and it will direct you to their
page.
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When done, click on the words "PayPal the
safer easier way to pay online."  >>>>>>>>>