Fredericton Girls+ ROCK Jam!!!
We are pleased to announce that Charlotte Street Arts Centre will be hosting a weekly rock n' roll jam for girls, trans and gender non-conforming people from ages 11-17. The weekly jam sessions will run every Thursday from 3:30-5pm beginning on March 15th until April 19th. It will take place at Charlotte Street Arts Centre. The goal of the jam sessions is to empower, teach and provide a supportive environment for self-expression, cooperation and self-confidence through musical expression. The weekly jam sessions will be drop in style so no need to feel like you have to commit to coming each week but if you do we would love to see you!! Also this weekly jam is FREE thanks to our friends at the Fredericton Community Foundation. Please fill out the form below if you are interested in joining us! This will be a great warm up for our Fredericton Girls Rock Camp coming this summer. If you have any questions please call 454-6952 or email nbgirlsrock@gmail.com
Email address *
Full Legal Name: *
Your answer
Preferred Name:
Your answer
Date of Birth: *
MM
/
DD
/
YYYY
Age: *
Your answer
Medicare Number *
Your answer
Home Address: *
Your answer
Parent/Caretaker Info
Name of Parent/Caretaker: *
Your answer
Phone Number of Parent/Caretaker: *
Your answer
Email of Parent/Caretaker : *
Your answer
Emergency Contact (someone other than the parent/caretaker named above)
Name: *
Your answer
Relationship to the youth: *
Your answer
Phone Number: *
Your answer
Email address: *
Your answer
Is there other contact information we might need to know? This may include other people that are authorized to pick up your camper or if they are allowed to walk home after our sessions, etc. *
Your answer
Health Information:
Any information requested below is asked solely to help us take the best possible care of your youth; it is held in the strictest confidence and will only be share with those who need to know (staff & facilitators).
Any medical conditions or allergies? Yes or no, if yes please list: *
Your answer
Any emotional, behavioural or developmental concerns? Yes or no, if yes please tell us a bit more so we can ensure they get the support needed during our weekly sessions: *
Your answer
Are there any medications that we need to be aware of (epi-pen, etc)? *
Your answer
Tell us about you...
We'd like to know how you learn best so we can try our best to meet your learning needs. Please check all that apply. I learn best by:
We'd like to know how you learn best so we can try our best to meet your learning needs. Please check all that apply. I learn best by: *
Required
What are you most excited to learn or experience ? *
Your answer
Have you had any music lessons? If yes, which instruments? *
Your answer
Media Permission:
During our weekly sessions we will be making audio and visual recordings. These recordings and photos are only used t promote the camp and Charlotte Street Arts Centre.
Do you consent to allowing audio/visual recordings/photos? *
Submit
Never submit passwords through Google Forms.
This form was created inside of Charlotte Street Arts Centre. Report Abuse - Terms of Service - Additional Terms