registration forms (PDF, 4 pages) - Pacific Northwest Quarterly Meeting

PNQM Registration – April 24-26, 2015
Registration Last Name
Meeting
Address (including Zip Code)
Email
Will your family attend full time (Friday evening – Sunday lunch)?
Yes, or
If No, please add a note telling when each person plans to arrive and leave.
Other needs (specify in a
note)
Need Near Bathroom
I snore
Certified in CPR?**
Certified in First Aid?**
1st time at PNQM?
Plan to lead an IG?
Lodging Choice
Check if "yes"
Meal Choice
Work Time - 2nd Choice
Work Time -1st Choice
Work Contribution -1st Choice
Work Contribution -2nd Choice
Worship Group Choice
Child's Activity Group
Age*
First Name
(Add last name ONLY
if it differs from
Registration Last
Name above)
Gender (M, F or O [Other] )
See Codes – next page
No
Need Lower Bunk
Telephone
* Age: W e are now asking for the age of all attenders (adults only to the decade). For adults, this information will
be used only to assist in the appropriate assignment of work contributions and for balancing small worship groups.
** If certified in First Aid and/or CPR, please add a note with expiration date(s) if known and indicating whether yo u
are willing to be a medical volunteer if needed. However, if you've already given us this information on the
registration form for Fall 2008 or later, it's not necessary to do so again unless something has changed.
Family Chosen Fee – see “Pay What
You Can” policy in Information Packet
$10.00 Early discount before 3/24/14
Are there children coming with you who have
allergies or special needs? If so, it's
essential that our Children's Program
Coordinator knows in advance:
$25.00 Late fee after 4/12/14
Total
Paid at registration***
Balance due at check-in
***At least 50% of fees should be paid at time of registration by mailing a check payable to "PNQM" to:
Don Billen, PNQM Treasurer / 2911 S. Massachusetts St. / Seattle, WA 98144. Please write the
Registration Last Name (see above) on the Memo line of your check.
Mail or E-mail this page by September 15th
to our Registrar:
John Gotts
102 15th Ave
Lewiston, ID 83501
johnwm@xmission.com
208-790-0651
You must register in advance (by March 23) so Lazy F can plan for food &
accommodations, and so our Children's Program Coordinator can determine
which children will be in each activity group
Codes for filling out the Registration Form (previous page)
Children’s Activity Groups
Junior Friends (Grades 9-12)
JF
Central Friends (Grades 6-8)
CF
Upper Elementary (Grades 3-5)
UE
Early Elementary (Grades K-2)
EE
Preschool (Ages 3-5)
PS
Infants and Toddlers
IT
Worship Group Choices
Worship Sharing
WS
Worship Discussion
WD
Worship with Music
WM
Worship Walking
WW
Worship Hiking
WH
Unprogrammed Worship
UW
None
Work Contribution – 1 st and 2 nd Choices (adults only)
Help with Children’s Program
CPA
IT
PS
EE
UEY
UEN
CFY
CFN
OC
FAP
Any age group
Infants and toddlers
Preschool
Early Elementary
Upper Elementary – Hike OK
Upper Elementary – No Hike
Central Friends – Hike OK
Central Friends – No Hike
Junior Friends Overnight Chaperone
Junior Friends Daytime Friendly Adult Presence
Other opportunities:
Set up chairs and tables in meeting room
SU
Small Worship Group Leader
WGL
Physician, Nurse, EMT, etc.
MED
Quarterly Meeting Staff
QS
End-of-session cleanup in a specific common area
CU
Other: Specify what on registration form
Oth
Unable to contribute this time
UN
Work Times – 1 st and 2 nd Choices
P
W
I
F
Meal Choices
M
Ve
Va
GM
GVe
GVa
Meat eater
Vegetarian
Vegan
Gluten Free Meat eater
Gluten Free Vegetarian
Gluten Free Vegan
During a Plenary Session
During a Worship Group
During Interest Groups
During unscheduled times
Lodging Choices
IN
T
RV
O
Indoors
Tent
RV
Off Campus
PACIFIC NORTHWEST QUARTERLY MEETING
Interest Group Form
Interest groups are an opportunity to share interests and skills with others. Leaders might be experts,
amateurs, or just plain interested in a topic. They are held Saturday afternoon for an hour and a half (or
less, if you wish.)
Some

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
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ideas:
Theme-related
The work of a Friends organization, such as AFSC, FWCC, or FCWPP
Sing Along & Silly Songs—sing traditional favorites, then make up new words – share the best of
both at community night
Yoga, Qi Gong, Aikido or some other physical -spiritual practice
Writing workshop
Artistic or other activity that both youth/children and adults can enjoy together
Hiking or walking
Anything that is a passion for you will interest others. Use your imagination!
I am interested in leading an interest group
I'll facilitate the group alone
Suitable for all ages?  Yes
OR
I'll facilitate with
, or No
Number of participants No Limits
.
If no, explain
OR Minimum #
.
Maximum # _____
Special needs (movable chairs, large space, etc)
.
.
Name:
Address:
E-mail:
Phone:
Cell:
Short description of topic and how you envision working with it, as you wish it to appear on sign-up sheets:
Name of Interest Group:
Description:
Submit ideas and questions to the Interest Group Coordinator, Amy Merrill, amymerrill@yahoo.com,
206-679-6439 If you have no questions, complete the form and mail or email to Amy (be sure to keep a
copy for yourself).
If you tell us about your Interest Group in advance, we will make a sign-up sheet for you. If you offer
one only after arriving, you'll need to create your own sign-up sheet (we'll provide "blanks").
.
.
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PACIFIC NORTHWEST QUARTERLY MEETING
YOUTH SPONSORSHIP FORM
MUST be filled out twice (or once and photocopied) for EACH child or youth
under 18 years of age attending Quarterly Meeting without a parent or guardian
One copy is to be given to the Sponsor listed below, and one copy included with your child’s
registration.
My child,
, has my permission to attend the weekend
retreat of Pacific Northwest Quarterly Meeting, April 24 -26, 2015, at Lazy F Camp and Retreat
Center near Ellensburg, WA.
(an adult attending this
Quarterly Meeting session) has agreed to sponsor and supervise him/her.
I understand that the group may participate in outdoor activities. I agree to hold Pacific
Northwest Quarterly Meeting, the Religious Society of Friends, and Lazy F Camp and Retreat
Center harmless for any injuries which may be sustained as a result of my child's participation in
the retreat.
My child may be given emergency medical treatment if necessary, with the consent of the
sponsor named above or an adult leader of the activity group for this age child.
Emergency Contact
Phone Number
Alternate Contact
Phone Number
Special Medical Conditions
Medications
Parent/Guardian Signature