Name:FirstLastPreferred Name (if different):Address:Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountryHome Phone:-Area CodePhone NumberCell Phone:-Area CodePhone NumberE-mail:Best way to contact you: *Home PhoneCell PhoneEmailHow old will you be at the time of camp?T-shirt SizeYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLAdult 2XEmergency ContactsFirst Emergency Contact's Name:FirstLastEC1 Relationship:EC1 Home Phone:-Area CodePhone NumberEC1 Work Phone:-Area CodePhone NumberEC1 Cell Phone:-Area CodePhone NumberSecond Emergency Contact’s Name:FirstLastEC2 Relationship:EC2 Home Phone:-Area CodePhone NumberEC2 Work Phone:-Area CodePhone NumberEC2 Cell Phone:-Area CodePhone NumberDietary Preference, Allergies and Medical InfoDietary Restrictions:VeganVegetarianOmnivoreOtherDo you have any food allergies or medical information we should know about?Intern Positions and Job DescriptionsInstrument you can teach or coach. GuitarBassDrumsKeyboardVocalsAre you interested in working with Rebel Girls! (campers age 8-10 or new campers):YesNoMentorship Position Preference:Junior Camp Counselor – Assisting with camper bandsInstrument Instructor – Assisting instrument classShowcase Crew - Helping out at the showcaseAssembly Crew – help run the morning and afternoon assemblies, including: skits, playing the camp song, gamesRoadies – Assist moving gear and setting up for next activityWorkshops – Assisting with workshopsWould you be interested in playing during a lunchtime performance? (by yourself or with your band if you have one):YesNoAre you able to move and lift musical equipment such as guitars, drums and small amps? Dollies will be provided. Safety is always a priority and no one will be asked to do anything unsafe. *Do you have any special skills you would like to share with us? Crafting, technical, computer, musical, organizational, etc. Express YourselfDear Intern Candidate, We want to get to know you better. Please respond to ALL of the following questions in your own words. You may email or mail a written response - handwritten is preferred but typed is acceptable. OR you may email an audio (.mp3) or video (.mov) response. Use the space provided below or email your response to: rachel@girlsrockdallas.org. Please put "Intern Express Yourself Piece" in the subject line and include your name in the email. If you are mailing a response, mail it to: Girls Rock Dallas, P.O. Box 600387, Dallas, TX 75360 . This address is not an office, it is a mailbox ONLY. We are looking for thoughtful and honest self-expression. There are no right or wrong answers. Just be yourself. We may contact the Intern candidate for a follow-up phone interview. Please send your Express Yourself response within ONE WEEK of when this application was submitted. Your Intern application is considered incomplete until we receive your Express Yourself piece. QUESTIONS: 1) What was one GREAT experience you had at GRD summer camp? What was one CHALLENGING experience? 2) What would you do to make summer camp more awesome? 3) Why are you excited about being a GRD Intern?Express Yourself: *type_submit_reset_49SubmitReset
