Girls Rock! Camp 2018 Application
Thank you in advance for taking the time to complete the camper 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! There's lots more information about camp, and about this application process on the Girls Rock! Camp Info Sheet, which is available at the same place on our website where you found this form.

Girls Rock! Camp Sessions:
Session One: Monday, July 30th to Saturday, August 4th
Session Two: Monday, August 13th to Saturday, August 18th

Both sessions will take place at Cathedral High School in Midtown Manhattan (350 East 56th street, NYC 10022), with the final Saturday showcases at another venue TBD.

GR!C is for ages 8-18. Campers at Willie Mae Rock Camp come from a wide range of economic experiences, ethnic identities, gender identities, & boroughs, and more than half self-identify as youth of color. Incoming campers must be 8 before the program begins.

We will only consider applications that are complete. If you have any questions, please call 347-599-0716 or e-mail info@williemaerockcamp.org.
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Si deseas una solicitud en español, por favor escribe a info@williemaerockcamp.org o llama a 347-599-0716.

Для материалов на русском языке, пожалуйста, напишите: info@williemaerockcamp.org

한국어 자료는 전자 메일로 보내주십시오.: info@williemaerockcamp.org

对于普通话材料,请电子邮件: info@williemaerockcamp.org

Pou materyèl nan kreyòl, tanpri imèl: info@williemaerockcamp.org

بالنسبة للمواد باللغة العربية، يرجى إرسال بريد إلكتروني:
info@williemaerockcamp.org

Camp Session *
Please indicate which camp session you are applying for:
Are you interested in the other session if your first choice is unavailable? *
ABOUT THE CAMPER
Camper's First Name *
Camper's Last Name *
First Name as you would like it to appear on camper badge
If different from legal name
Camper's Email Address
If applicable. Campers will be invited to all our youth oriented social media groups!
Camper's Date of Birth *
MM
/
DD
/
YYYY
Camper's Age *
At time of camp.
Camper's Gender Pronouns
Gender Pronouns are the pronouns that an individual would like others to use when talking to, or about, that individual. Check all that apply.
Camper's School Name *
Please list school's FULL, OFFICIAL name (i.e P.S. 316 Elijah Stroud)
Current Grade in School
If the camper is currently enrolled in school
This school is *
Primary Address *
City *
State *
Zipcode *
Secondary Address
If applicable
Secondary City
If applicable
Secondary State
If applicable
Secondary Zipcode
If applicable
CAREGIVER INFORMATION
Please list the person who will be receiving all of 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 First Name *
Primary Contact Last Name *
Primary Contact Email Address *
Primary Contact Phone Number *
Primary Contact Alternate Phone Number
Primary Contact's Relationship to Camper *
Does Primary Contact Live in: *
Secondary Contact First Name
Secondary Contact Last Name
Secondary Contact Email Address
Secondary Contact Phone Number
Secondary Contact Alternate Phone
Secondary Contact's Relationship to Camper
Does Secondary Contact Live In:
Name of Person Filling Out Application
If not already listed
Relationship to Camper
Email
If you will be the main contact for notifications
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