Girls Rock Camp 2017: Session 2 Registration
Instructions
Hello future rockers (and rocking parents/guardians)!

This registration form is for Girls Rock Camp SESSION 2, AUGUST 14-18, 2017 for campers ages 11-13 in or entering middle school (6th-8th grade) in fall 2017.

Registration deadline: May 1, 2017

This form should be filled out by a parent/guardian, except the section 'About Music & More!,' which should be filled out by the camper.

Application fee: $10. Follow the payment instructions at the end of this form to complete your application. We cannot accept your application until the fee is submitted.

Thanks!
Girls Rock! Rhode Island

Camper Info!
To be completed by parent/guardian
Camper first name
Your answer
Camper last name
Your answer
Camper preferred name (if different than above)
The name that will be printed on their nametag at camp
Your answer
Camper address
Street and Apt/Floor/Unit #
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Camper phone number
Your answer
Camper email
Your answer
Date of birth
MM
/
DD
/
YYYY
Age at time of camp
You must be 11-13 years old to attend Girls Rock Camp SESSION 2. Campers will participate in developmentally appropriate activities.
Grade camper will enter in fall 2017
You must be entering 6th, 7th, or 8th grade in fall 2017 to attend Girls Rock Camp SESSION 2.
School camper will attend in fall 2017
Your answer
What kind of school is this?
Name of primary contact/parent/guardian
First and last name
Your answer
Relationship to camper
Your answer
Primary contact best phone number (XXX-XXX-XXXX)
Your answer
What type of phone is this?
Primary Contact Alternate Phone Number (XXX-XXX-XXXX)
Optional
Your answer
What type of phone is this?
Primary contact email
Email is our main mode of communication. Please provide a current, valid email address that you check regularly
Your answer
What is the best way to contact you?
What is the best time to contact you?
Your answer
Primary contact employer
Your answer
Primary contact job title
Your answer
Secondary contact name
First and last name. In case of emergency only.
Your answer
Relationship to camper
Your answer
Relationship to primary contact
Your answer
Secondary contact best phone number (XXX-XXX-XXXX)
Your answer
What type of phone is this?
Secondary contact email address
Your answer
Secondary contact employer
Your answer
Secondary contact job title
Your answer
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