Jumpstart 2018 Application
*READ ME*

Thank you for your interest in our Jumpstart 2018 program!

Jumpstart 2018 will take place from:
Monday, July 16th to Friday, July 20th, 2018
Location: Cathedral High School in Midtown Manhattan (350 East 56th street NYC 10022)

It is a week of workshops, music instruction, and band practice, with a showcase that Friday! This program is for ages 5-7 (incoming campers of 5 must provide documentation of age prior to notification, Campers must be 5 by June.)

Once completing this form you will be notified after application review to submit additional forms and tuition for camp.

*PLEASE NOTE: Notifications will be sent on the 3rd Thursday of every month until the deadline*

ABOUT THE CAMPER
Camper's First Name *
Camper's Last Name *
Camper's Preferred Name
Camper's Preferred Gender Pronouns
Camper's Date of Birth *
*PLEASE NOTE* Rock Camp Jumpstart is for campers ages 5 - 7. Campers who are listed as 5 will have to provide documentation of age prior to camp. As an organization we do not turn away undocumented families, so this does not have to be a birth certificate if you do not have access. For information about our program for campers aged 8 - 18, please visit: http://williemaerockcamp.org/programs-page/girls-rock-camp-2018/
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Documentation of camper's age
Camper's Age at Start of Camp *
Primary Address *
City *
State *
Zipcode *
Neighborhood *
Secondary Address (if applicable)
City
State
Zipcode
Name of Camper's School (if applicable)
Grade in School (if applicable)
This School is (if applicable)
FAMILY/CAREGIVER INFORMATION
Please list the contact who will be receiving all the notifications as the primary contact. If secondary contact resides in the same household they will be listed on the notification emails as well.
Primary Contact's First Name *
Primary Contact's Last Name *
Primary Contact's Email *
Primary Contact's Phone *
Primary Contact's Alternative Phone
Primary Contact's Relationship to Camper *
Does Primary Contact Live in: *
Secondary Contact's First Name
Secondary Contact's Last Name
Secondary Contact's Email
Secondary Contact's Phone
Secondary Contact's Alternative Phone
Secondary Contact's Relationship to Camper
Does Secondary Contact Live In:
Name of Person Filling Out Registration Form
If Not Listed Already
Relationship to Camper
Email
If you are the main person for receiving notifications, please provide your email in this section
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