Youth Rock Camp 2020: Session 2 Registration
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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.

Girls Rock! Rhode Island
Camper Info!
To be completed by parent/guardian
Camper first name *
Camper last name *
Camper preferred name (if different than above)
The name that will be printed on their nametag at camp
Camper address *
Street and Apt/Floor/Unit #
Camper phone number
Camper email
Date of birth *
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.
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.
School camper will attend in fall 2020 *
What kind of school is this? *
Name of primary contact/parent/guardian *
First and last name
Relationship to camper *
Primary contact best phone number (XXX-XXX-XXXX) *
What type of phone is this? *
Primary Contact Alternate Phone Number (XXX-XXX-XXXX)
What type of phone is this?
Clear selection
Primary contact email
Email is our main mode of communication. Please provide a current, valid email address that you check regularly
What is the best way to contact you? *
What is the best time to contact you?
Primary contact employer
Primary contact job title
Secondary contact name
First and last name. In case of emergency only.
Relationship to camper
Relationship to primary contact
Secondary contact best phone number (XXX-XXX-XXXX)
What type of phone is this?
Clear selection
Secondary contact email address
Secondary contact employer
Secondary contact job title
Clear form
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