Please fill out one registration form per family. All lodging will be based on single gender housing in dorm style buildings. 

* 1. Participant Information #1

* 2. Participant Information #2 (leave blank if not applicable)

* 3. Participant Information #3 (leave blank if not applicable)

* 4. Participant Information #4 (leave blank if not applicable)

If you have more than four participants in your family please contact Kate Akerman at kakerman@nyac.com

* 5. Emergency Contact Information

* 6. Do any of the above participants have any dietary restrictions? If yes, please explain

* 7. Do any of the above participants have any special skills or areas of interest that they're interested in contributing to our Service Weekend? If so, please list. Ex: Gardening, power tool experience, etc.

* 8. Tell us more about your connection to Quinipet

* 9. Quinipet Camp & Retreat Center ________ have permission to use photographs of all above listed participants in any promotional and social media postings.

* 10. I would like to pay the $60/person Quinipet Service Weekend fee by ______. This fee includes lodging, food, and supplies for the weekend.

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