Youth Rock Camp 2020: Session 2 Registration
* Required
Instructions
Hello future rockers (and rocking parents/guardians)!
This registration form is for Youth Rock Camp (formerly called Girls Rock Camp) SESSION 2, August 10-15, 2020 for campers ages 14-18 (in or entering high school age, 9th-12th grade in fall 2020) at JamStage in Pawtucket.
Registration deadline: June 15, 2020
This form should be filled out by a parent/guardian, except the section 'About Music & More!,' which should be filled out by the camper.
Application fee: $10. Follow the payment instructions at the end of this form to complete your application. We cannot accept your application until the fee is submitted.
Thanks!
Girls Rock! Rhode Island
Camper Info!
To be completed by parent/guardian
Camper first name
*
Your answer
Camper last name
*
Your answer
Camper preferred name (if different than above)
The name that will be printed on their nametag at camp
Your answer
Camper address
*
Street and Apt/Floor/Unit #
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Camper phone number
Your answer
Camper email
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Age at time of camp
*
You must be 14-18 years old to attend Girls Rock Camp SESSION 2. Campers will participate in developmentally appropriate activities.
Choose
14
15
16
17
18
Grade camper will enter in fall 2020
*
You must be entering 9th, 10th, 11th or 12th grade in fall 2018 to attend Girls Rock Camp SESSION 2.
Choose
9th
10th
11th
12th
School camper will attend in fall 2020
*
Your answer
What kind of school is this?
*
Public
Charter
Private
Parochial
Other:
Name of primary contact/parent/guardian
*
First and last name
Your answer
Relationship to camper
*
Your answer
Primary contact best phone number (XXX-XXX-XXXX)
*
Your answer
What type of phone is this?
*
Cell
Home
Work
Other:
Primary Contact Alternate Phone Number (XXX-XXX-XXXX)
Optional
Your answer
What type of phone is this?
Cell
Home
Work
Other:
Clear selection
Primary contact email
Email is our main mode of communication. Please provide a current, valid email address that you check regularly
Your answer
What is the best way to contact you?
*
Email
Call
Text
Other:
What is the best time to contact you?
Your answer
Primary contact employer
Your answer
Primary contact job title
Your answer
Secondary contact name
First and last name. In case of emergency only.
Your answer
Relationship to camper
Your answer
Relationship to primary contact
Your answer
Secondary contact best phone number (XXX-XXX-XXXX)
Your answer
What type of phone is this?
Cell
Home
Work
Other:
Clear selection
Secondary contact email address
Your answer
Secondary contact employer
Your answer
Secondary contact job title
Your answer
Next
Page 1 of 7
Never submit passwords through Google Forms.
This form was created inside of Girls Rock! Rhode Island.
Report Abuse
Forms
