Queer Camp 2025 Camper Registration

Welcome to Arkansas' only summer camp where LGTBQIA+ youth and allies can feel safe, celebrated, loved, and valued by each other and their community. Queer Camp offers a unique opportunity to let loose, have fun, and be who you are without any hesitation or fear of judgement. It's a perfect setting to meet new people and make new connections for youth, their families, and their wider networks. The camp is staffed by numerous 2SLGBTQIA+ adults who want to provide a fantastic experience for 2SLGBTQIA+ youth.

Queer Camp is a weeklong day camp for middle school, junior high, and high school students (ages 12–18) running from Monday July 7th through Friday July 11th, 9 a.m. to 6 p.m. To ensure camp security, schedule details and camp location will be sent via email (queercampnwa@gmail.com) to registered campers about a month before camp begins.

You can contact us with any questions or concerns at: 479-521-2113 or queercampnwa@gmail.com

Camper Information

Legal First & Last Name

Camper's Chosen Name

Camper's Pronouns

Camper's Email (optional)

Camper's Birthday

Grade Completed at the end of the 2024-25 School Year

T-Shirt Size

Is your camper a licensed driver who will be driving themselves to and from camp?

Yes

No

Did your Camper attend Queer Camp last year?

Yes

No

How many years in total has your camper attended Queer Camp?

Parent/Guardian Information

First name

Last name

Name(s) of other parent/guardian(s)

Phone Number(s)

Email

Country/Region

Address

City

Zip / Postal code

Emergency Contact Name(s)

Emergency Contact(s) Phone Number(s)

List names of anyone other than Parent/Guardian(s) who is allowed to pick up the camper.

Camper's Health & Medical Needs

Does the camper have any of the following allergies or medical conditions?

Provide details about the above medical conditions (optional)

List any medications your camper might bring with them to camp. Please list dosage & frequency.

Select any dietary restrictions or food allergies that apply to your camper.

Provide details about the above dietary restrictions or food allergies (optional)

Does your camper have any unique physical, emotional or spiritual needs our staff should know about?

Permissions & Camp Participation Agreements

Is your camper allowed to use insect repellant or sunscreen?

Insect repellant

Sunscreen

No to both

Is your camper allowed to receive a free hair cut?

Yes

No

Do you give permission for your camper to ride with a Queer Camp staff member or other camper parent on a securely monitored field trip?

Yes

No

Waiver & Release of Liability

I hereby give my permission for the child(ren) under my care to participate in Queer Camp. Participation in any program which involves physical activity exposes the camper to certain risks and dangers. Accidents and injuries are always a possibility, and it is impossible to foresee and protect the camper from all conceivable dangers. I hereby affirm that I have disclosed any conditions that would make it unsafe for the child(ren) under my care to participate in Queer Camp. I understand that reasonable measures will be taken to safeguard the health and safety of all Queer Camp participants and that I will be notified as soon as possible in case of any emergency affecting the child(ren) under my care. In the event that I cannot be reached in an emergency, I hereby authorize emergency contact for the child(ren) under my care to act on my behalf. Furthermore, if the emergency contact nor I can be reached, I authorize Queer Camp/Good Shepherd Lutheran Church to select a physician and/or hospital to provide emergency medical and surgical treatment and to provide routine health care; to administer medications; to order x-rays, routine tests, treatment; to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation. I understand that my insurance is the primary coverage and that I will be responsible for any/all fees incurred during emergency medical services for the child(ren) under my care.

I understand that the child(ren) under my care can be dismissed from camp for reasons including, but not limited to: consistently disruptive behaviors, illegal activity, persistent breaking of camp rules, emotional or physical abuse of another camper or staff member, contagious illness, or destruction of property. Acknowledging that participation in camping programs carries with it the risk of injury, I agree that Queer Camp, its agents and staff shall not be liable to me or the child(ren) under my care for any injury or damage, howsoever caused, resulting directly or indirectly from the child’s participation in Queer Camp at any time preceding, during, or after camp is in session. I hereby discharge Queer Camp/Good Shepherd Lutheran Church, their agents and employees from all actions, claims, and demands my child or I may have for any such injury or damage. I hereby grant permission to Queer Camp leadership, staff, and screened volunteers to involve my child in adventure/group building activities as part of the regular camp program.

I agree

By selecting "I agree" above and signing your full name below, you acknowledge:

The information provided by you on this form is complete and accurate.
You have been provided an opportunity to ask questions or voice concerns about any of the information one this form.
You fully understand and agree to all information and terms laid out on this form.

Signature

Registration Payment

You must pay the registration fee in order to complete registration. Campers who have not paid may not be eligible to attend camp.

If you are in need of a scholarship, you must select a scholarship option AND complete the scholarship form below in order to be eligible.

Select the appropriate Registration Payment option

Pre-registration (1/1/25-2/28/25)$200

Open Registration (3/1/25-5/31/25)$250

Late Registration (6/1/25-6/31/25)$300

I need a partial scholarship for my camper. (Must complete scholarship form.)$150

I need a full scholarship for my camper. (Must complete scholarship form.)$0