Girls Rock Vermont - Camper Application 2019
Although the required questions are indicated by a red asterisk, we ask that you answer every applicable question. Your application will not be received until you select "Submit" on the last page and see the confirmation message that will pop up.
Email address *
First Name *
Your answer
Last Name *
Your answer
date of birth *
(mm/dd/yyyy)
Your answer
Which session are you hoping to attend? *
If your first choice of session fills up, are you available for the other session? *
What name or nickname would you like on camp materials (name badge)?
Your answer
Who are some of your favorite bands or musicians?
Your answer
Does the Camper Have Experience Playing a Musical Instrument? *
Remember, we do not require any previous musical experience and all levels of experience are encouraged to apply!
Please indicate what instrument(s), and for how many years.
Your answer
Camp Instrument
Instrument Choice *
We will do our best to accommodate your first choice, but cannot guarantee it
First Choice
Second Choice
Third Choice
Fourth Choice
Fifth Choice
Drums
Guitar
Bass
Keyboards
Ukulele
Do you plan to bring your own guitar, bass or keyboard to camp? *
Parent/Guardian Emergency Contact Information *
Your answer
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Home Address (including Town/City) *
Your answer
Mailing Address
If different from above
Your answer
Home Phone *
Your answer
Work Phone *
Your answer
Cell Phone *
Your answer
What is the best way to contact you with routine information or questions?
Choose One
CAMPER MEDICAL AND BEHAVIORAL INFORMATION
Please list all known conditions so that we may accommodate your camper’s needs. All 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 or allergies? *
If yes, please list:
Your answer
Is the camper on any medication to treat these conditions?
If yes, please list:
Your answer
Does the camper have any behavioral or emotional issues? *
If yes, please list:
Your answer
Is the camper on any medication to treat these conditions?
If yes, please list:
Your answer
Is there anything else you feel we need to know about the camper in order to best accommodate their needs?
Your answer
Financial Aid
Financial Aid Request
If you are requesting full or partial tuition assistance and/or free lunch at camp, please indicate your needs here and answer questions 1, 2, and 3 from the Demographics Survey that follows.
If you selected Partial Tuition Assistance, please indicate how much you can pay. (Full tuition is $350.)
The amount of tuition assistance that we have available is based on our fundraising campaigns and we will do our best to meet your needs. We will contact you and confirm the amount of assistance we can offer.
Your answer
Please use this space to write in any additional information that you would like us to know regarding your request for assistance.
Your answer
Demographics Survey
Please fill out the following demographics survey. Creating a group of campers that reflects the diversity of Vermont communities is a camp priority. In addition, some of our potential funders require the racial/ethnic and economic composition of our camp population to be documented in aggregate anonymously. Providing the following information will help us meet our goals and help us to receive funding for future camp sessions. Thank you so much for your time & information!
1. Does the camper qualify for free/reduced lunch?
Your answer
2. Estimated household annual income
Your answer
3. How many people live in your household?
Your answer
4. Please check any and all that apply to your camper, or write her preferred identity
How did you hear about us? (Both for the first time and more recently?)
Please be as specific as possible, including names! (List friends, websites, news organizations, etc.) We would like to know which areas of outreach are working for us, so the more detail you provide, the better!
Your answer
What size T-shirt will your camper need?
A copy of your responses will be emailed to the address you provided.
Submit
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