Summer 2017 Camper Application
Thank you for your interest in Bay Area Girls Rock Camp!

Our summer camp is a week-long program for girls ages 8-18. Campers attend instrument lessons, form a band, collaboratively write an original song, participate in daily music and empowerment-related workshops, and perform with their band at a live showcase at the end of the week.

Summer 2017 Dates:

Session 1: June 12th - 16th // Showcase June 17th
TEEN WEEK: July 10th - 14th // Showcase July 15th  (open to campers ages 13-18)
Session 3: July 24th - July 28th // Showcase July 29th

Camp will be held at Oakland School for the Arts in Downtown Oakland. Camp runs Monday through Friday from 9am to 5pm. Showcases will take place at the New Parish in downtown Oakland on Saturday from 2-5pm.

Tuition is $0-$500 sliding scale, with no one turned away for lack of funds. Full and partial financial aid is readily available. If you plan on applying for financial aid, please fill in the financial aid application in addition to this application so that we can determine your tuition amount.

Please give us at least a week to respond to your application.  

If you have any questions or problems filling out this form, please give us a call at (510) 267-1808 or email shawna@bayareagirlsrockcamp.org 
Sign in to Google to save your progress. Learn more
What is your first choice session? *
What is your second choice session? *
Camper's first name *
Last name *
Email address of Parent/Guardian *
Street address *
City *
State *
Zip Code *
County *
School attending in Fall 2017 *
Grade level camper is entering in Fall 2017 *
Date of Birth *
MM
/
DD
/
YYYY
Age at time of camp *
Teen week is for campers 13 and up
Name of Parent/Guardian *
Cell number of Parent/Guardian *
Home/Additional numbers of Parent/Guardian *
Camper cell number
Which is the best way to contact you *
Has your camper attended any of our previous programs? *
Select all that apply
Required
FIRST INSTRUMENT CHOICE *
Choose the instrument you'd most like to play. We'll do our best to make sure you get your 1st or 2nd choice.
Experience *
No experience is necessary, but let us know what experience you have, if any. How long have you been playing? Have you had lessons? Have you played this instrument at camp before? Or are you trying this instrument for the first time?
SECOND INSTRUMENT CHOICE *
Experience *
No experience is necessary, but let us know what experience you have, if any. How long have you been playing? Have you had lessons? Have you played this instrument at camp before? Or are you trying this instrument for the first time?
Express Yourself Piece *
We'd like to hear from potential BAGRC campers about why they want to participate. THE EXPRESS YOURSELF PIECE IS NOT FOR JUDGEMENT PURPOSES. Please have the applicant write a brief letter about herself (parents/guardians should not write this letter on behalf of the applicant). Applicants may also tell us why they want to attend rock camp through a drawing, painting, song, video, etc. Paper pieces should be no more than 8.5" x 11" and can be mailed or emailed to us. She can type the letter directly into the space below, or send it via email to shawna@bayareagirlsrockcamp.org, or by mail to P.O. Box 72213 Oakland, CA. 94612.
Are you applying for financial aid? *
It is our mission to be accessible to all girls regardless of their families' financial situation. We offer a sliding-scale tuition of $0 - $500. Applying for financial aid will not affect your chances of getting into a program and we encourage you to ask for assistance if you need it. We offer full and partial financial aid upon request, and no one is turned away for lack of funds. If you decide to apply for financial assistance, please fill out the financial aid application (separate) in addition to this application.
Do you participate in the free lunch program at your school? *
T-shirt size *
First emergency contact *
Name and relationship to camper
Contact phone number *
Second emergency contact *
Name and relationship to camper
Contact phone number *
Does the camper have any medical conditions, allergies, dietary restrictions or special needs the staff should be aware of? *
Is the camper taking medication to treat a physical condition? *
Does the camper have any behavioral or emotional issues the staff should know about? If yes, is she taking any medications? *
We ask this so that we can be sure we are able to best serve our campers and have adequate staff on hand if special attention is needed. In no way will this affect whether or not your camper is accepted into camp.
Are you interested in carpooling?
If yes, write the area that you will be coming from in the "Other" box
Host Families
Host families are provided on a voluntary basis so we can not guarantee availability. Families who would like to host must have an attending camper and provide transportation to and from camp.
Clear selection
How did you hear about our program? *
Required
Which of the following racial groups comes closest to identifying you? Check all that apply, and use the "other" box to share any additional ethnicity information. *
We dislike checkboxes, too! They are helpful for grant reporting, though, so please bear with us.
Required
Liability Release and Media Consent
I understand that attending camp will involve activities such as, but not limited to, a loud environment, self-defense, active group games, using electrical equipment and moving heavy equipment and objects. I fully accept and assume all such risks and all responsibility for losses, costs and damages that may incur as a result of the camper's participation in camp activities. *
In case of emergency, accident, illness, or other incapacity occuring while under the Camp's authority, I give my permission for the camper to be treated by medical professionals and admitted to the hospital if necessary.  This authorization applies whether or not the charges are covered by my insurance, and I am responsible for all reasonable medical and emergency expenses. *
I authorize Bay Area Girls Rock Camp staff/volunteers to take audio, video and photographic recordings of this camper. Bay Area Girls Rock Camp shall own all rights to recordings and photographs, to be used and disposed of at the discretion of the Bay Area Girls Rock Camp.   *
Audio, video and photos are primarily used for brochures & flyers, and on our website. Camper names are never used without explicit parent/guardian consent; you will be contacted by a staff member before any names are used. SELECTING NO MEANS THAT YOUR CAMPER'S BAND PHOTO AND SHOWCASE PERFORMANCE WILL NOT BE AVAILABLE TO VIEW ONLINE.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Bay Area Girls Rock Camp. Report Abuse
Google Forms