Ladies Rock Camp Application 2017
Hello! Thank you for your interest in Ladies Rock Camp, and for taking the time to read & complete the application. Please know that all of the information you provide contributes greatly to our efforts to make rock camp a supportive and fun environment for everyone. We appreciate your participation in that effort!

Applying to Ladies Rock Camp is a 2-part process:

Part 1: Filling out this form!
Part 2: After reviewing your application, we will confirm your spot via email and ask you to submit your tuition payment. After payment, your registration will be complete.

We will only consider applications that are complete. If you have any questions, please call 347-599-0716 or e-mail info@williemaerockcamp.org.

Si deseas una solicitud en español, por favor escribe a info@williemaerockcamp.org o llama a 347-599-0716.

This year, Ladies Rock Camp will take place from Friday, June 23rd to Sunday, June 25th, 2017.

Email address
CONTACT INFORMATION
First name of participant
Your answer
Last name of participant
Your answer
Preferred name (if applicable)
Your answer
Preferred Gender Prounouns
Preferred Gender Pronouns, or PGPs, are the pronouns that an individual would like other to use when talking to, or about, that individual. Check all that apply.
Date of birth
MM
/
DD
/
YYYY
Age
Your answer
CONTACT INFORMATION
Email address
Your answer
Primary phone number
Your answer
Alternate phone number
Your answer
Mailing address
Your answer
City
Your answer
State
Your answer
Zip code
Your answer
Neighborhood
Your answer
EMERGENCY CONTACTS
First contact's name
Your answer
Email
Your answer
Primary phone number
Your answer
Alternate phone number
Your answer
Relationship
Your answer
Second contact's name
Your answer
Email
Your answer
Primary phone number
Your answer
Alternate phone number
Your answer
Relationship
Your answer
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