Girls Rock Louisville 2016 Summer Camp Camper Application
Thank you for your interest in Girls Rock Louisville’s summer camp! Please read and complete this application carefully. Camp is open to girls* and gender non-conforming youth ages 10 to 18 years old. Camp will take place at Central High School in Louisville from MONDAY, JULY 18th to SATURDAY, JULY 23 from 9:00 AM until 4:30 PM. All participants in the camp will perform with their band at the showcase on FRIDAY, July 22ND and participate in a special recording session at LaLaLand studio on SATURDAY, JULY 23rd. More details to be announced!

Our mission is to empower girls* 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 skills of collaboration, problem solving, and positive self-expression 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 rock venue and record a song in a professional recording studio– all in one week’s time. Throughout each session, GRL also provides daily workshops geared towards building self-esteem and encouraging self-expression and 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.

Camp activities begin at 9:00 AM and end at 4:30 PM each day. Campers can arrive as early as 8:30 AM. Instruments will be provided to all campers and no musical experience is required!

We have limited space available, so please submit your application by the deadline, JUNE 18, 2016. It is very important that campers attend the full week of camp and the showcase 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 in the future.

We seek to support each child who wants to participate in Girls Rock Camp. We also recognize that not all members of our community have equal access to financial resources. One way we can acknowledge these economic differences and provide access to our programs for all campers is by providing sliding scale tuition. With our sliding scale tuition, each family is able to determine how much they are able to contribute to our program. We do not want tuition costs to deter anyone from applying to camp.

Contact Information
Camper Name *
Your answer
Home Address *
Your answer
Parent/Caretaker 1 Name *
Your answer
Relationship to Camper *
Your answer
Parent/Caretaker 1 Email Address *
Your answer
Parent/Caretaker 1 Phone Number *
Your answer
Parent/Caretaker 1 Preferred Method of Communication *
Would you like to be added to our mailing list to learn about future events and programs? *
Parent/Caretaker 2
Your answer
Relationship to Camper
Your answer
Parent/Caretaker 2 Email address
Your answer
Parent/Caretaker 2 Phone number
Your answer
Preferred Method of Communication
Would you like to be added to our mailing list to learn about events and future programs?
Camper Information
Date of Birth (include year) *
Your answer
Camper ethnicity (optional)
Your answer
Please list and elaborate on any medical conditions or allergies of which we should be aware.
Your answer
Please list and elaborate on any behavioral, emotional or developmental issues of which we should be aware.
Your answer
Please list any and all medications the camper is taking to treat the above-mentioned conditions.
Your answer
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
What school does the camper attend? What grade will they be in next year? *
Your answer
T-shirt size *
Is your camper left or right handed? *
It is very important that campers attend the entire week of camp as they are part of a collaborative project. Please talk to us if your camper is not able to make this commitment. Will your camper be able to attend the full week of camp and the showcase? *
How did you hear about Girls Rock Louisville? *
Your answer
Information to be Completed by Camper
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, 2 by your second choice, and a 3 by your third choice out of the following options: GUITAR, BASS, DRUMS, VOCALS, KEYBOARD *
Your answer
What musical experience do you have with these instruments? What other musical experience do you have? *
Your answer
What do you hope to learn at camp? *
Your answer
We believe that young people (like you!) can 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
Tuition Information
Full tuition for the week of camp is $250. This includes instruments, materials for workshops, art supplies, camp t-shirts, band t-shirts, lunch and snacks for all campers. 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 $100
$35,000 to $45,000 $175
$45,000 to $80,000 $250 (full tuition)
more than $80,000 $350 (full tuition plus a partial scholarship for another camper!)
More than $80,000 $500 (full tuition plus a full scholarship for another camper!)

Requested tuition amount: *
Your answer
Final piece of the GRL camp application: Express Yourself Piece
We want to know who you are, why you want to attend Girls Rock Louisville summer camp, what music means to you, or anything else you’d like us to know! There are a million ways to express these things- write a letter, a story, a poem, make a collage or video, draw a picture- anything that can fit on one 8 1⁄2” x 11 size page or on a CD. Please mail it in with your application. Please understand that this piece will not be returned to you, so send us something that we can keep! You will not be judged in anyway by this piece- it doesn’t have any effect on whether you are accepted to camp or not- it’s just to help us get to know you. This piece can be submitted digitally (email to or through snail mail (P.O.Box 4533 Louisville, KY 40255)
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