Camper Application | Girls Rock Dallas

Camper Name*

First Last

Camper's Preferred Name

Camper's Gender Pronouns*

She/Her
They/Them
Ze/Zir
He/Him

Date of Birth*

Age (at time of camp)*

Camper Email*

This will be used to add campers into our online platforms only.

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

T-Shirt Size*

Parent/Guardian Information

Name of Parent/Guardian*

First Last

Primary Phone Number*

Secondary Phone Number

Email*

Best way to contact you*

How did you hear about Girls Rock Dallas? Please be as specific as possible (list names, media, online source, places, etc.)*

Racial/Ethnic Identity (optional)

Creating a multiracial group of campers that reflects Dallas communities is a camp priority. In addition, some of our funders require that the racial/ethnic and economic composition of our camp population be documented. Providing the following information will help us meet our goal of being a multiracial camp and help us continue to receive funding for future camp sessions.

Please check ANY AND ALL that apply, or write in your preferred identity

Asian/Pacific Islander
Black/African American/Caribbean American
Chicana/Latina
Middle Eastern/Arab American
Native American/Indigenous
White/European American
Other

If other, please list here.

Medical and Behavioral Information

The following information is very important, as it helps us provide the best care and supervision we can. All medical/behavioral information will be kept confidential, and shared only with the camp nurse and staff as necessary to provide proper care.

Does the camper have any medical conditions, allergies (including food), dietary restrictions or any other issues that the staff should know about?

Does your camper experience any of the following? Please select all that apply.

ADHD
Sensory Processing Disorder
Anxiety
Learning Disabilities
Depression
ODD
ASD
Conduct Disorders

Relationships

How would you describe your camper's personality?

Are there any campers attending camp (that you know of) that we should not put your child with in a band? (This can include siblings, friends, bullies, etc.)

Virtual Camp

Camper Availability*

Mornings (9am - 12pm)
Afternoons (12pm - 5pm)
Evenings (5pm - 9pm)

What technology does your camper have access to?*

Computer/Laptop
Chromebook
School provided Chromebook
iPhone
Android phone
iPad
Other Tablet

Do you have access to an internet connection with a minimum bandwidth of 600kbps?*

You can run a test of your connection speed here: https://speed.measurementlab.net/

Yes
No

Instrument Choice (you must select a different instrument for all three choices)

Choose the instrument you would most like to play. No experience is necessary for choosing these instruments. We’ll do our best to make sure you get your first or second choice.

Instrument - First Choice*

First Choice - Experience*

Beginner (0-1 year)
Intermediate (2-3 years)
Advanced (4+ years)

Instrument - Second Choice*

Second Choice - eExperience*

Beginner (0-1 year)
Intermediate (2-3 years)
Advanced (4+ years)

Instrument - Third Choice

Third Choice - Experience

Beginner (0-1 year)
Intermediate (2-3 years)
Advanced (4+ years)

What instruments do you have at home?*

Instruments will be provided for campers that do not have access to one.

Guitar
Bass
Keyboard/Piano

If you are a beginner, tell us why you chose your top two instruments.

If you have had any previous musical and/or collaborative experiences with these or other instruments, please tell us about them.

Please check if you are:*

Right-handed
Left-handed
I use both

What are you listening to these days? (List bands/musicians/songs.)*

Express Yourself Piece

We would like to hear from NEW campers to help us to get to know you better! (Tell us about your musical experience, why you want to rock or anything else you would like us to know). Returning Campers: Please put "returning" in the space provided below. You are not required to submit an EYP this year.

Express Yourself Piece*

You're Almost Done!

If you are not applying for financial assistance, please scroll down and click the submit button at the end of the form. If you are applying for financial assistance, please complete the questions below.

Financial Assistance

Girls Rock Dallas seeks to offer financial assistance to all campers who may otherwise not be able to attend our camp. Applying for financial assistance will neither increase nor decrease your chances of being accepted into the program. We encourage you to ask for assistance if you need it. Please consider your family income, resources and dependents in the household when determining your financial aid request amount. This process is honor-based and confidential. Directions: Fill out this form, one for each camper for whom you are applying. Electronically sign and submit the form with your program application. You may be contacted for a follow-up phone interview.

How much can you pay towards your child's camp cost?

What is the annual income of your family?

Are you a single income family?

Other information that may be helpful in calculating the level of assistance provided?

I verify that all the information I have provided in this document is true to the best of my knowledge. By typing your name below, you are electronically signing that the information you are providing in this document is true and to the best of your knowledge.

Apply for Summer Camp

Camper Application 2020 Virtual