Registration: FROM AARGH or UGH to AHHHH 6th -8th grade (Nov 17, 2017 - Nov 19, 2017 )

USER INFORMATION
First Name:
Last Name:
Address:
1
City:
State:
Zip:
Email:
Phone:
Would you like to be included on the carpool list? The list is sent to people who are on it.:
yes  no  
Gender:
Birth Date:
select your current grade:
1
Parents' names:
Parents e-mails:
1
Check any of these restrictions that apply (you may explain details in the next box):
vegetarianveganallergy-specify belowno gluten
Explain any specific food needs or things that the cook should know:
1
I am planning to arrive by train and would like to be on a list of people willing to share a taxi:
Hudson Amtrak (from NYC)  Albany Amtrak (from the west)  
1
Your Quaker meeting or other faith community:
1
Note any concerns we should be aware of (health, accesibility, etc.):
1
I would like the first time attender youth discount:
yes  
1
Enter the amount of financial aid you are requesting from Powell House:
1
The following information I have given here is new:
mailing addressphone numbere-mailfood needs
Please note here anything else we should know.:
The deposit amount will appear automatically on the confirmation page. You may change the amount by typing in what you want to pay at this time (above the minumum deposit).

Powell House is the conference and retreat center of the 

New York Yearly Meeting of the Religious Society of Friends (Quakers).

Powell House
524 Pitt Hall Rd
Old Chatham,  NY
12136
phone  518-794-8811
fax     518-794-8815
Adult Program 
sharon@powellhouse.org
regina@powellhouse.org
Youth Program
chrisandmike@powellhouse.org