Girls Rock Camp Jax 2017 Camper Application
Girls Rock Jacksonville cultivates self-empowerment and positive identity development in girls, trans, and gender non-conforming youth through music experimentation, DIY media, and peer collaboration. Girls Rock Jacksonville 2017 will take place from July 24th ~ July 28th at Unitarian Universalist Church at 7405 Arlington Expy from 9am to 5pm each day, with the camper showcase on Saturday, July 29th. Showcase time and location is TBA!

Program Description and Schedule!

Each day begins with a morning assembly including snacks, announcements, skits, and warm up activities like "punk rock aerobics". After assembly, instrument instructors teach guitar, bass, drums, and keyboard—the assigned instrument will be based on the campers' selection below. No musical experience is required.

Campers and volunteers enjoy a family style lunch together, then watch...dance to....and sing along with a local music performance, ending in an open Q&A, where campers can ask the performer(s) questions about their art, life, identities, etc!!

Campers will also participate in workshops and have free time throughout the day. Workshops are designed to spark discussions about diverse experiences and delve further into musical skills. These creative and empowering workshops are centered around DIY creativity, social justice, writing, image/identity, and more!

Campers are formed into bands on day one and practice their original song(s) each day after lunch and workshops. Each band will work collaboratively with the guidance and mentorship of a volunteer band coach and counselor. The camp week ends on Saturday with a public showcase where the youth perform their songs.

Please read the below mission statement, core values, and statement of diversity carefully, it is very important to our program that our parents, guardians, and caretakers are aware of what drives us to do this work, how we do this work, and who our work is for.

Mission Statement

Girls Rock Jacksonville cultivates self empowerment and positive identity development in girls, trans, and gender non-conforming youth with music experimentation, DIY media, and peer collaboration!

Core Values

We value the power of music as a means to create personal and social change;
We value efforts that actively expand opportunities for girls and women;
We value positive approaches to fighting sexism;
We value integrity, honesty and respect;
We value critical thinking;
We value appropriate sharing of resources, cooperation, and collaboration;
We value using our collective voice to further our mission;
We value diversity.

Statement of Diversity/Non-Discrimination Policy

Girls Rock Jacksonville values diversity of age, race, economic status, gender expression, size, physical ability, developmental ability, musical interests, learning styles, nationality, religion, thought, citizenship status, and sexual orientation. We promote respect and do not tolerate racism, sexism, homophobia, or other discriminatory behavior or expression.

~IMPORTANT INFO~

Please complete and submit the following application by June 6th. If you apply after this deadline note that acceptance into camp is not guaranteed. We will notify waitlisted campers of their spot on the list and give further directions at that time.

Annual Household Income = Suggested Tuition

less than $20,000 = $0-$100
$20,000 to $30,000 = $100-$175
$30,000 to $50,000 = $175-$275
$50,000 to $70,000 = $275-$375
$70,000 to $90,000 = $375-$475
more than $90,000 = $475+

**Camp tuition is sliding scale, meaning that each campers' tuition is decided by the caretakers of the camper, based on their household income. No camper is turned away based on their household income, or their preferred tuition amount. We ask that you will please take the needs of your household in consideration as well as the needs of GRJ, as we are a grassroots organization and rely solely on volunteer labor and donations.**


Contact us:
E-mail: girlsrockjacksonville@gmail.com
Snail Mail: P.O. Box 3523, Jacksonville, FL 32206
Website: http://girlsrockjacksonville.org/


Important Dates!
June 6th ~ Camper applications Due
July 24th ~ First Day of Camp!
July 29th ~ Camper Showcase!

Camper Contact
Camper's First and Last Name: *
Your answer
Home address:
Your answer
City, State, Zip:
Your answer
Mailing address: *
If same as home address, write "same"
Your answer
City, State, Zip:
If same as above, write "same":
Your answer
Camper e-mail address:
Your answer
Parent/Guardian Information
Parent/Guardian Full Name: *
Your answer
Relationship to camper:
Your answer
Parent/Guardian E-mail Address: *
Your answer
Parent/Guardian Home Phone:
Your answer
Parent/Guardian Cell Phone:
Your answer
Parent/Guardian Work Phone:
Your answer
Which phone number would be best to reach parent/guardian during camp hours? *
Your answer
Parent/Guardian 2
Parent/Guardian 2 Full Name:
Your answer
Parent/Guardian 2 E-mail Address:
Your answer
Relationship to camper:
Your answer
Parent/Guardian 2 Home Phone:
Your answer
Parent/Guardian 2 Cell Phone:
Your answer
Parent/Guardian 2 Work Phone:
Your answer
Which phone number would be best to reach parent/guardian during camp hours? *
Your answer
Please list the names of any folks who may pick up camper. *
Please note that anyone on this list will be asked to show identification at pick up. We will not release a child to this contact without photo identification. NOTE: Please let us know if there is anyone who is NOT permitted to pick up your camper.
Your answer
Emergency Contact Information
Emergency Contact Name: *
Your answer
Relationship to camper:
Your answer
Emergency Contact Primary Phone Number: *
Your answer
Emergency Contact Additional Number:
Your answer
Tuition

Annual Household Income = Suggested Tuition

less than $20,000 = $0-$100
$20,000 to $30,000 = $100-$175
$30,000 to $50,000 = $175-$275
$50,000 to $70,000 = $275-$375
$70,000 to $90,000 = $375-$475
more than $90,000 = $475+

Please select an amount:
Please select a payment method:
Please keep a record of which tuition amount you chose. Tuition is due by July 16th. If you chose PayPal, please indicate the name of the camper you're paying for in the notes section. All checks should be sent to to P.O. Box 3523 Jacksonville, FL 32206. Make payable to "Girls Rock Jacksonville".
Camper Information
Camper Age: *
Your answer
Camper Date of Birth: *
Your answer
Camper Race/Ethnicity (optional):
Your answer
T-shirt Size *
Please describe any behavioral, emotional, or developmental accommodations we should be prepared for, and how we can support them:
We need to know this so that we can rock an inclusive learning environment for our campers.
Your answer
Please list any medical conditions/food or drug allergies
Your answer
We have a Registered Nurse at camp all times and are able to provide basic over-the-counter medications/first aid to campers should they need medical attention. If a situation arises in which your camper needs first aid we will contact you. *
Please indicate your preference. (basic meds include tylenol and motrin)
Required
Please list any medications camper is currently taking:
If taking any medications please indicate if we need to store them for your camper.
Your answer
Dietary Accommodations *
We provide snacks and lunch for our campers each day. We need to know about dietary preferences so that we can order all the right foods in advance. If your camper would like to bring their own lunch that's alright too!
Required
Camper Questions!
It is super important that camp applicants fill this section out for themselves.
Campers ~ Please answer the following questions honestly and thoughtfully. We want to get to know you a little before camp!
What name do you prefer to go by?
If the same as your legal name, you can leave this blank!
Your answer
What are your preferred gender pronouns?
ex. she/her, he/him, they/them
Your answer
What school do you go to? What grade are you going into?
Your answer
Have you ever attended a Girls Rock Camp?
If so, where, and what instrument did you play?
Your answer
How did you hear about Girls Rock Jacksonville?
Your answer
What is your first instrument choice to play at camp this summer? *
No experience necessary! We will try to make sure you get your first choice.
What is your second choice of instruments? *
Please choose something different than your first choice.
And a third choice? *
Just in case.
Do you have any experience with these or any other instruments? The more detail the better! (it is not required to have experience, we just want to know so we can put you in the best instrument class!)
Your answer
Do you have any other musical experience you would like us know about? (it doesn't have to be formal experience, if you love to sing when you're alone, or have a band with your friends, that totally counts)
Your answer
List any hobbies/interests you have. *
Do you like to paint? Are you a master chef? Do you like to play games? Are you into photography? Do you draw comics about adventures with your friends? Possible answers are endless!
Your answer
What do you like about you? (what makes you unique, strong, influential, totally awesome?)
Your answer
Do you have any personal role models? Who are they and what do you admire about them?
Your answer
If you could change anything about the world, what would it be?
Your answer
Are there any specific topics or interests that you'd like to see in a workshop?
Your answer
Is there anything else about you that you would like us to know?
Your answer
Please tell us how we can best support you at camp? *
We all have our own unique needs and personalities, and we really want to know the best way to make the space comfortable for you. We will do everything we can to make this happen. We also encourage you to let us know throughout the week as things come up! <3
Your answer
Creative Projects!
We would like to see a little bit of you. Whether it's a drawing, painting, poem, song, photo, zine page, screenprint, birdhouse, whatever, just something creative! We would like to get to know you more and see what your creative style is.

Please send creative projects to P.O. Box 3523, Jacksonville, FL 32206 by July 1st!

Video and digital projects can be e-mailed to girlsrockjacksonville@gmail.com

Media Release *
(Bring your parent/guardian back for this part!)
Camper's Electronic Signature and Date:
Your answer
Parent/Guardian Electronic Signature and Date:
Your answer
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