Girls Rock Vermont - Camper Application 2022
Camp Dates: June 27- July 1 at Main Street Landing.

Although the required questions are indicated by a red asterisk, we ask that you answer every applicable question. Your application will not be received until you select "Submit" on the last page and see the confirmation message that will pop up.
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Email *
Camper's First Name *
Camper's Last Name *
Camper's date of birth *
(mm/dd/yyyy)
What are the camper's pronouns? *
Does the Camper Have Experience Playing a Musical Instrument? *
Remember, we do not require any previous musical experience and all levels of experience are encouraged to apply!
Please indicate what instrument(s), and for how many years.
What size T-shirt will your camper need? *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Home address (PLEASE include city and state!!!) *
Mailing Address
If different from above
Home Phone *
Work Phone *
Cell Phone *
What is the best way to contact you with routine information or questions?
Choose One
Clear selection
Parent/Guardian Emergency Contact Instructions *
CAMPER MEDICAL AND BEHAVIORAL INFORMATION
Please list all known conditions so that we may accommodate your camper’s needs. All information will be kept confidential and shared only with the camp staff as necessary to provide proper care.
Does the camper have any medical conditions or allergies? *
If yes, please list:
Is the camper on any medication to treat these conditions?
Clear selection
Does your camper receive support in order to be successful at school? *
Does the camper need any behavioral or emotional supports? *
If yes, please list:
Is there anything else you feel we need to know about the camper in order to best accommodate their needs?
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