Apply for Summer Camp Camper Application 2020 Virtual Camper Name* First Last Camper's Preferred NameCamper's Gender Pronouns* She/Her They/Them Ze/Zir He/Him Date of Birth* Date Format: MM slash DD slash YYYY 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*SelectYouth XSYouth SYouth MYouth LAdult XSAdult SAdult MAdult LAdult XLAdult XXLParent/Guardian InformationName of Parent/Guardian* First Last Primary Phone Number*Secondary Phone NumberEmail* Best way to contact you*SelectPhoneEmailHow 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 InformationThe 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 RelationshipsHow 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 CampCamper 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/YesNoInstrument 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*SelectBassElectronic DrumsGuitarKeyboardVocalsFirst Choice - Experience* Beginner (0-1 year) Intermediate (2-3 years) Advanced (4+ years) Instrument - Second Choice*SelectBassElectronic DrumsGuitarKeyboardVocalsSecond Choice - eExperience* Beginner (0-1 year) Intermediate (2-3 years) Advanced (4+ years) Instrument - Third ChoiceSelectBassElectronic DrumsGuitarKeyboardVocalsThird 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 PieceWe 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 AssistanceGirls 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?SelectYesNoOther 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. Help Us Rock DonateGet Involved