Girls Rock Louisville Summer Camp 2017 Application
Thank you for your interest in Girls Rock Louisville Summer Camp! We are looking forward to receiving your application. Please read it carefully – there is a lot of information and we cannot consider incomplete applications. Camp is open to girls and gender non-conforming youth ages 10 to 18 years old.

CAMP INFO:
Our mission is to empower girls and gender-nonconforming youth to believe in themselves by providing a supportive community that fosters self-expression, confidence, and collaboration through music education and performance. In a weeklong summer session run by adult community volunteers, girls gain meaningful life experiences of collaboration, problem solving, self-expression, and social justice awareness in a creative, supportive environment.

Campers will meet and form bands, learn how to play an instrument (guitar, bass, keyboards, drums, or vocals), compose original songs and perform live to hundreds of family, friends, and community members at a local music venue (Headliners Music Hall) and record a song in a professional recording studio (La La Land) – all in one week’s time. Throughout each session, GRL also provides daily workshops geared towards building self-esteem and encouraging self-expression and social justice awareness.

At GRL, we seek to create a supportive community of peers and positive mentors that encourage and teach girls to be their own music heroes, allowing them to think differently about limits that may be placed upon them by our society. Our programming provides unique opportunities that are rarely found elsewhere: we use music as a vehicle to eradicate limiting myths about gender and age; we increase access and exposure to music education and hands-on learning; and our programming encourages collaboration, leadership skills, and self-confidence.

IMPORTANT DATES:
April 4- Camp Applications Open
April 28- Camp Applications Close*
May 1- Parents are Notified of either Acceptance or Wait List Status
May 8- Parent Confirmation of Camper Participation Due
May 16- Camper Tuition Payment Due- please DO NOT send payment until you have been notified of your camper's application status

*We have limited space available, so please submit your application by the deadline, APRIL 28, 2017. It is very important that campers attend the full week of camp, the showcase, and recording session so they can participate in the entire program. If your child is unable to attend the full week, we ask that you consider applying again another time.

COST OF CAMP:
Full tuition for the week of camp is $275. This includes instruments, materials for workshops, art supplies, camp t-shirts, band t-shirts, lunch and snacks for all campers, dinner prior to the June 16th showcase concert, as well as the opportunity to record in a professional recording studio and perform at a real music venue. Girls Rock Louisville receives most of our funding through program tuition and grassroots fundraising. We rely on support from our community to run and grow our programming.

FINANCIAL AID:
Girls Rock Louisville uses sliding scale tuition to allow families to pay what they can for tuition. Factors to consider when determining the amount you can contribute include: total household income, number of dependents in the household (children or extended family members to care for), or extenuating circumstances such as medical costs or loss of employment. Our sliding scale system is based on trust. We use this system to ensure economic diversity among our campers and to make camp financially accessible for all.

HOW TO COMPLETE THIS APPLICATION:
•Please have the parent/guardian review these sections, and have campers fill out the section, "To Be Filled Out by Camper"
•Please note that we require every camper to submit an "Express Yourself" piece. We want to know more about you and why you want to attend rock camp. Applications are not complete until Express Yourself Pieces are received via email or postal mail.

Camper Name (First and Last)
Your answer
Date of Birth
MM
/
DD
/
YYYY
Age (at time of camp)
Your answer
Home Address (Street Address, City, State, and Zip Code)
Your answer
Is your mailing address different?
If so, what is your mailing address?
Your answer
Name of Parent/Guardian
Your answer
Primary Phone Number
Your answer
Secondary Phone Number
Your answer
Parent/Guardian Email Address
Your answer
How did you hear about Girls Rock Louisville?
Your answer
What school do you currently attend?
Your answer
What ethnicity/ethnicities do you (camper) consider yourself? Select all that apply to you. (This question is for reporting our camp demographics and will not impact your acceptance to camp.)
To Be Filled Out By Camper
Please be sure to let camper answer the questions in this next session, as it is hard for us to accommodate requests to switch instruments once camp has started.
What is your preferred instrument to play at camp this summer? Please list in order your preferences and put a "1" by your first choice, a "2" by your second choice, and a "3" by your third choice out of the following options: GUITAR, BASS, DRUMS, VOCALS, KEYBOARD. Note: You do NOT need to have prior experience on this instrument. The more flexible you are about instruments, the more likely we can accommodate you at camp! (Note: If you are a vocalist, you can still have an opportunity to sing in your band in addition to playing an instrument.)
Your answer
What is your experience, if any, with your instrument of choice?
Your answer
What other music experience have you had?
Your answer
Name a few of your favorite bands/musicians
Your answer
We love beginners! If you are a beginner, please tell us why you chose your instrument of choice.
Your answer
Are you left handed or right handed?
Why do you want to come to Girls Rock Louisville summer camp? Please write 1-2 paragraphs explaining what you hope to learn or how you want to grow this summer.
Your answer
We believe that young people (like you!) can help use their voices and their music to help create change in their communities. What problems do you see that you would like to help solve? Are there any issues that you are passionate about?
Your answer
We want to know more about you - why you want to attend rock camp and what music means to you. There are a million ways to express yourself: write a poem, a story, or a letter; make a collage; draw a picture; make a video; record a song; et cetera. Please know that these pieces may not be returned to you, so send us something we can keep. Please make sure your piece is no bigger than 8.5x11.
How do you want to submit your "Express Yourself" piece?
To be filled out by Parent/Guardian
In case parent/guardian is unavailable, please list name of an emergency contact name
Your answer
Relationship to camper
Your answer
Emergency Phone Number
Your answer
Does the camper have any medical conditions or allergies? If so, please list below.
Your answer
So that we may best serve your child, please let us know of any specific needs she may have in any emotional, behavioral, social, or learning areas. (If none, please type "No specific needs.")
Your answer
Is the camper on any medication(s) to treat any of the above-mentioned condition(s)?
Let us know if there are any significant circumstances or family situations affecting your camper that you would like to let us know about (for example: recent move or parents going through a divorce).
Your answer
T shirt Size (all sizes are in Adult unisex sizes)
We provide lunch from local businesses each day and do our best to accommodate campers' dietary needs. Please indicate any restrictions below.
Statement of Commitment
It is very important that campers commit to attending all of the sessions below as they are part of a collaborative project with bandmates who will be relying on their participation.

June 12-17- Summer Camp at Western Middle School
June 16- Showcase concert at Headliners Music Hall
June 17- Camper Recording Session at La La Land Studio
The camper will be able to attend ALL sessions of GRL Summer Camp
Tuition Information
Full tuition for the week of camp is $275. This includes instruments, materials for workshops, art supplies, camp t-shirts, camp recording session fees, the opportunity to perform in a real concert venue, lunches, snacks, and drinks for all campers, and dinner prior to the showcase concert. Girls Rock Louisville receives most of our funding through program tuition and grassroots fundraising. We rely on support from our community to run and grow our programming.

Girls Rock Louisville uses sliding scale tuition to allow families to pay what they can for tuition. Factors to consider when determining the amount you can contribute include: total household income, number of dependents in the household (children or extended family members to care for), or extenuating circumstances such as medical costs or loss of employment. Our sliding scale system is based on trust. We use this system to ensure economic diversity among our campers and to make camp financially accessible. Please be honest when selecting the tuition that is most appropriate for your family based on your economic resources. We encourage you to contribute what you can. Any amount contributed over $250 is considered a donation and is tax deductible. Additional donations will help us cover the costs of another camper!

Annual Household Income Suggested Tuition
less than $25,000 other or 0
$25,000 to $35,000 $125
$35,000 to $45,000 $200
$45,000 to $80,000 $275 (full tuition)
more than $80,000 $375 (full tuition plus a partial scholarship for another camper!)
More than $80,000 $525 (full tuition plus a full scholarship for another camper!)

Requested Tuition Amount
Your answer
Girls Rock Louisville Media Release & Liability Form
I, Parent/Legal Guardian of (child’s name insert below) hereby authorize Girls Rock Louisville and those acting pursuant to its authority, or with its permission, to interview and/or to have photographs, audio, or audiovisual recordings made of the above-named child (“Media Images”). I further grant permission to Girls Rock Louisville, its agents and assigns, to use the above-named child’s name, voice, photo, video, interview, performance and likeness for promotion of Girls Rock Louisville camps, programs, and events for all forms, media and manners, including, but not limited to footage, videos, audio recording, promotional pieces, documentaries, DVDs, documentaries, news releases, photographs, website, internet mediums, marketing, advertising, trade, promotion, and exhibition for an indefinite period of time. I give unrestricted permission for images, videos, and recordings of the child to be used in print, video, digital, and internet media in whole or in part. I agree that these images and/or voice recordings may be used for a variety of purposes and that these images may be used without further notifying me. Girls Rock Louisville shall own all rights, title, and interest in and to the Media Images, to be used an disposed of at the discretion of Girls Rock Louisville. I acknowledge that neither the child nor I will be compensated for the use of these Media Images. In consideration for my child's attendance at camp, campers hereby grant Girls Rock Louisville a nonexclusive, perpetual, irrevocable, royalty-free, fully paid-up, worldwide license to copy, sell and distribute in any manner any songs created by campers while attending Girls Rock Louisville (the “Songs”) and to incorporate the Songs, in whole or in part, into derivative works for sale and distribution without limitation. Campers retain ownership and all other rights in the musical compositions. Furthermore, in consideration for my child's attendance at camp, I hereby grant Girls Rock Louisville a nonexclusive, irrevocable, royalty-free, fully paid-up working license in the sound recordings that are created during my child's attendance at camp. I acknowledge that I have legal authority to approve this form on behalf of the minor named below.

In consideration of the acceptance of my child, into the Girls Rock Louisville summer camp this year, I hereby acknowledge and ASSUME THE RISKS BOTH KNOWN AND UNKNOWN related to my child’s participation in this activity and, to the fullest extent permitted by the law, WAIVE, RELEASE, AND DISCHARGE GIRLS ROCK LOUISVILLE, INC. FROM ANY AND ALL CLAIMS FOR DAMAGES FOR DEATH, PERSONAL INJURY, PERMANENT DISABILITY OR PROPERTY DAMAGE, that I may have or my child may have, or that may subsequently accrue to or my child, as a result of my above-named child’s participation in this year’s Girls Rock Louisville summer camp, whether or not resulting from negligence or misconduct of Girls Rock Louisville, Inc. and their agents, employees, volunteers, sponsors, affiliates, and Board Members.

I further understand and agree that this GENERAL RELEASE AND WAIVER OF LIABILITY applies to the fullest extent permitted by the law to WAIVE, RELEASE, AND DISCHARGE GIRLS ROCK LOUISVILLE, INC. FROM ANY AND ALL CLAIMS FOR DAMAGES FOR DEATH, PERSONAL INJURY, PERMANENT DISABILTY, OR PROPERTY DAMAGE that may arise from any transportation provided to or for my child during my child's participation in Girls Rock Louisville's summer camp by any agent, employee, volunteer, affiliate or Board Member of Girls Rock Camp Louisville. I acknowledge and ASSUME THE RISKS BOTH KNOWN AND UNKNOWN related to the provision of such transportation.

Parent/Guardian Initials
Your answer
Submit Application
In addition to this form, you'll need to send in, via mail, the following:
•The “Express Yourself” piece, uploaded via email to girlsrocklouisville@gmail.com or sent via Postal Mail. Make sure your name is on it! Your application is NOT complete without this important piece!

By Postal Mail:
Girls Rock Louisville
PO BOX 5433
Louisville, KY 40255


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