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12th Annual D2GB Children's Performing Arts Camp - Individual Application Form
Date: Monday July 29th to Friday Aug 2nd, 2019
Time: 9:30am to 3:30pm each day

Note: Parents are responsible for transportation to and from our location.

Note: There will be a limit to the number of 7-8 year old participants accepted. They will need to show proof of age (ex: birth certificate, etc.) upon acceptance.

Application Deadline: Friday June 14, 2019

Email address *
Camper's Name/Nombre del participante *
Your answer
Camper's Age/Edad del Participante *
Your answer
Camper's Address/Dirección del Participante *
Your answer
Parent/Guardian Name: Nombre del Padre/Guardian *
Your answer
Parent/Guardian Email: Email del Padre/Guardian *
Your answer
Parent/Guardian Phone: Numero de Telfono del Padre/Guardian *
Your answer
In case of an emergency, please provide the name and phone number of the person we should contact: En caso de emergencia, escribe el nombre y numero de telefono. *
Your answer
Have you been a part of our D2GB Camp before?/ Has participado en nuestro campamento? *
Please describe how the applicant is currently "going beyond" and how the applicant can benefit from this program: Por favor describe como el aplicante actualmente se ATREVE A MAS y como podria beneficiarse de este programa. *
Your answer
If you could share a message with your community, what would that be?: Su pudieras comunicarle un mensaje a tu comunidad, que les dirías? *
Your answer
Do you want to register for R.Evolución Latina's Dance-a-thon, an event that fundraises for programs like this? *
A copy of your responses will be emailed to the address you provided.
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