Ladies Rock Camp 2017 Application
We are so happy that you are interested in being a camper at Girls Rock Louisville's very first Ladies Rock Camp program! LRC is similar to what youth do during our summer camp: receive instrument instruction, form a band, and write and perform an original song in just four days! In addition, you will attend a variety of workshops with topics related to being an empowered rocker.

LADIES ROCK CAMP DATES: OCTOBER 5-8, 2017 at La La Land
Thurs. 6-9 pm/Fri 6-9 pm/ Sat. 10 am-8 pm/Sun 10 am-3 pm
Showcase concert at 7 pm.

LRC is for any woman or gender non-conforming individual over the age of 21 who wants to rock out while supporting GRL! There is absolutely no musical experience necessary and we will provide all instruments for all who attend.

Tuition for LRC will be on a sliding scale ($200 – $400) based on how much you are able to contribute. All proceeds from LRC go directly to supporting future Girls Rock Louisville programming.

*We have very limited space available (only 16 spots!), so please submit your application as soon as possible. It is very important that participants commit to attend all sessions of the program and the showcase. If you are unable to attend the full week, we ask that you consider applying again another time.

First and Last Name *
Your answer
Preferred Name (if different from first name):
Your answer
What is your gender pronoun? (Optional) http://www.transstudent.org/pronouns101
Your answer
Street Address: *
Your answer
City, State, Zip Code: *
Your answer
Phone number *
Your answer
Email address *
Your answer
Do you prefer text message or email to communicate with GRL about LRC? *
Birthdate *
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DD
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YYYY
Music Information
Our acceptance process prioritizes the date the application was received, the number of spaces available, and instrument choice. The more flexible you are able to be on your instrument choices, the more likely it is we can admit you!
At LRC camp, I would like to learn: (please indicate your 1st-4th choice of the following options: electric guitar, electric bass, drums, and vocals) *
Your answer
Describe your musical experience (No musical experience is needed to attend LRC!) *
Your answer
Tell us why you want to come to Ladies Rock Camp (in a few sentences) *
Your answer
T shirt size *
Emergency Contact Name *
Your answer
Relationship to Emergency contact *
Your answer
Emergency contact phone number *
Your answer
Emergency contact alternate phone number *
Your answer
Do you have any medical, accessibility, translation, or other needs and concerns and, if so, how do you need them to be accommodated?
Your answer
What are your dietary needs?
Your answer
What's your favorite protest song or chant? (Real and existing or imagined and future!)
Your answer
Tuition Information
Full tuition for the week of camp is $275. This includes instruments, materials for workshops, camp t-shirts, meals, snacks, and drinks, including wine and beer. Girls Rock Louisville receives most of our funding through program tuition and grassroots fundraising. We rely on support from our community to run and grow our programming.
Girls Rock Louisville uses sliding scale tuition in all of our programs to allow families and individuals to pay what they can. Our sliding scale system is based on trust. Please be honest when selecting the tuition that is most appropriate for you based on your economic resources. We encourage you to contribute what you can. Any amount contributed over $275 is considered a donation and is tax deductible. Additional donations will help us cover the costs for youth in our summer programs.

*Unfortunately, at this time we are not able to offer further tuition assistance, however, there are many other ways to be involved with Girls Rock Louisville! Please get in touch if you'd like to learn about other upcoming workshops, events, programs, and opportunities to volunteer: girlsrocklouisville@gmail.com.

Requested tuition amount (suggested donation of $200-400 or higher) *
Your answer
Girls Rock Louisville Media Release & Liability Form
I hereby authorize Girls Rock Louisville and those acting pursuant to its authority, or with its permission, to interview and/or to have photographs, audio, or audiovisual recordings made of myself. I further grant permission to Girls Rock Louisville, its agents and assigns, to use my name, voice, photo, video, interview, performance and likeness for promotion of Girls Rock Louisville programs, and events for all forms, media and manners, including, but not limited to footage, videos, audio recording, promotional pieces, documentaries, DVDs, documentaries, news releases, photographs, website, internet mediums, marketing, advertising, trade, promotion, and exhibition for an indefinite period of time. I give unrestricted permission for images, videos, and recordings to be used in print, video, digital, and internet media in whole or in part. I agree that these images and/or voice recordings may be used for a variety of purposes and that these images may be used without further notifying me. Girls Rock Louisville shall own all rights, title, and interest in and to the Media Images, to be used an disposed of at the discretion of Girls Rock Louisville. I acknowledge that I will not be compensated for the use of these Media Images. In consideration for my attendance at camp, I hereby grant Girls Rock Louisville a nonexclusive, perpetual, irrevocable, royalty-free, fully paid-up, worldwide license to copy, sell and distribute in any manner any songs created by campers while attending Girls Rock Louisville (the “Songs”) and to incorporate the Songs, in whole or in part, into derivative works for sale and distribution without limitation. Campers retain ownership and all other rights in the musical compositions. Furthermore, in consideration for my attendance at camp, I hereby grant Girls Rock Louisville a nonexclusive, irrevocable, royalty-free, fully paid-up working license in the sound recordings that are created during my attendance at camp.

I hereby acknowledge and ASSUME THE RISKS BOTH KNOWN AND UNKNOWN related to my participation in this activity and, to the fullest extent permitted by the law, WAIVE, RELEASE, AND DISCHARGE GIRLS ROCK LOUISVILLE, INC. FROM ANY AND ALL CLAIMS FOR DAMAGES FOR DEATH, PERSONAL INJURY, PERMANENT DISABILITY OR PROPERTY DAMAGE, that I may have as a result of my participation in this year’s Ladies Rock Camp summer camp, whether or not resulting from negligence or misconduct of Girls Rock Louisville, Inc. and their agents, employees, volunteers, sponsors, affiliates, and Board Members.

Participant's initials *
Your answer
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Thank you for your interest in LRC! We'll be in touch with you within the next week to let you know:)
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