Summer Camp Application

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5/19/17 – We are currently full for camp this summer. Please feel free to submit your application to join our waiting list.

CAMPER INFORMATION


Camper Name: *
Camper's preferred name (if different):
Date of Birth: *
 /  / 
Age (at time of camp): *
Address: *
T-Shirt Size: *
School District:
Student ID:

PARENT/GUARDIAN INFORMATION

Name of Parent/Guardian: *
Primary Phone Number: *
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Secondary Phone Number:
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E-mail: *
Best way to contact you: *
How would you prefer to receive paperwork from Girls Rock Dallas? *
How did you hear about Girls Rock Dallas? Please be as specific as possible (list names, media, online source, places, etc.): *

EMERGENCY CONTACT INFORMATION (Other than Parent/Guardian)

First Emergency Contact Name:
EC1 Relationship to Camper:
EC1 Primary Phone:
-
EC1 Secondary Phone:
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Second Emergency Contact Name:
EC2 Relationship to Camper:
EC2 Primary Phone:
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EC2 Secondary Phone:
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Is this person allowed to pick up your daughter after camp or in an emergency?

IMPORTANT:     In the event, you wish to authorize your daughter to be picked up by someone not listed above, please make sure to speak with camp staff and sign a release.

CAMP HOURS AND SUPERVISION REQUIREMENTS

Formal camp activities are scheduled to run from 9:00 am to 5:00 pm Monday to Friday. Check- in is from 8:00-9:00 am and check-out is from 5:00-5:30 pm. All campers must be picked up no later than 5:45 pm. We will have volunteers on-site as early as 7:30 am in case of early drop off; however we will not have full staff to camper ratios during that time. Girls dropped off early are expected to act in an adult manner under their own supervision.

I require early drop-off:
I hereby acknowledge the above policies. By electronically signing your name below, you are acknowledging the above policies for camp hours and supervision requirements. *

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

CARPOOLING (Optional)

Carpools are provided on a voluntary basis, and we cannot guarantee availability. Girls Rock Dallas does not accept liability for any camper’s or family’s behavior or actions.

I would like to find other campers near me to carpool with, if possible. I give Girls Rock Dallas permission to share my contact information with other families interested in carpooling.

MEDICAL 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. Please include any medications the camper is taking.

NOTE: If your child requires any medications to be administered during camp hours, please submit a doctor’s note and instructions with the medication to our nurse or other volunteer on the first day of camp. (A photocopy of a similar release used for school is acceptable).

Does the camper have any medical conditions, allergies, emotional/ behavioral issues, or any other issues that the staff should know about?
I allow Girls Rock Dallas Nurse to administer the following medication(s) on a as needed basis during camp week. These medications do not require a phone call to the parents during the day. *

INSTRUMENTS

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

Choice 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 1st or 2nd choice.


Instrument - First Choice *
First Choice - Experience *
Instrument - Second Choice *
Second Choice - Experience *
Instrument - Third Choice *
Third Choice - Experience
If you signed up for guitar or bass, will you be bringing your own instrument to camp? You are NOT REQUIRED to bring any instruments to Girls Rock Camp. We provide all instruments. Girls Rock Dallas does not accept liability for personal instruments. *
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: *
Name a few of your favorite bands and any songs you like to play or sing: *

Morning Workshops 

Older/returning (11-17) campers will have the choice to get in-depth and work the entire week (Tuesday-Friday) on one topic of their choosing. All new campers and campers ages 8-11 will be placed in the Rebel Girls! morning program. 

 Electives include (*subject to change):

 Songwriting: In-depth exploration on how to write a song, using poetic, melodic and harmonic methods.

 Techie 101: Learn how to work your own amps, distortion and looping pedals, as well as other aspects of live sound.

 Recording: Learn the ropes to recording on different technological interfaces like Garage band and recording booths.

 DJing: Learn from a local DJ the basics of DJ skills.

 Music Videos: Learn how to plan, stage and execute a music video.

Podcast/Radio: Learn how to create high quality audio and video podcasts. 

For returning and campers ages 11-17 please select your first and second choice for morning electives. New and campers ages 8-11 please select Rebel Girls! Program. *

Express Yourself Piece We would like to hear from NEW campers about why they want to participate. THE EXPRESS YOURSELF PIECE IS NOT FOR JUDGEMENT PURPOSES - IT WILL NOT AFFECT WHETHER OR NOT YOU ARE ACCEPTED INTO CAMP. Please have the applicant write a brief letter about herself (parents/guardians should not write this letter on behalf of the applicant). Applicants may also tell us why they want to attend rock camp through a drawing, painting, song, video, etc. She can type the letter directly into the space below, or send it via email to rachel@girlsrockdallas.org, or by mail to P.O. Box 600387, Dallas, TX 75360. If you choose to send your Express Yourself separately, please indicate whether you'll be sending it via email or postal mail.

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?
Do you participate in the free lunch program at your school?
Do you need lunch to be provided for your camper? Please note that due to limited resources, Girls Rock Dallas will only be providing lunch for campers with demonstrated financial need. If your child receives free or reduced price lunch at school, or if providing lunch is a financial burden for your family, then your child will be eligible for a camp lunch. Don't hesitate to let us know if any of these circumstances apply to your family. Girls Rock Dallas will continue to provide a morning and afternoon snack for all campers.
Other information you think we should know.
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.

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