We Rock! Camp Application 2017
Hello! Thank you for your interest in We Rock! Camp, and for taking the time to read & complete the application. Please know that all of the information you provide contributes greatly to our efforts to make rock camp a supportive and fun environment for everyone. We appreciate your participation in that effort!

Applying to We Rock! Camp is a 2-part process:

Part 1: Filling out this form!
Part 2: After reviewing your application, we will confirm your spot via email and ask you to submit your tuition payment. After payment, your registration will be complete.

We will only consider applications that are complete. If you have any questions, please e-mail kaci@girlsrockrochester.org

We Rock! Camp will take place from Saturday, November 11th to Sunday, November 12th, 2017.

PERSONAL INFORMATION
First name of participant *
Your answer
Last name of participant *
Your answer
Preferred name (if applicable)
Your answer
Gender Pronouns
Gender Pronouns are the pronouns that an individual would like other to use when talking to, or about, that individual. Check all that apply.
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
CONTACT INFORMATION
Email address *
Your answer
Primary phone number *
Your answer
Mailing address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
EMERGENCY CONTACTS
First contact's name *
Your answer
Primary Phone Number *
Your answer
Alternate Phone Number *
Your answer
Relationship *
Your answer
Second contact's name
Your answer
Primary phone number
Your answer
Alternate phone number
Your answer
Relationship
Your answer
Please list any dietary allergies, restrictions, or needs:
Your answer
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