Email janetbjordan@gmail.com for new application link

Name of camper attending *

First

Middle

Last

What is the age of the camper? *

What are the names of the parent or guardian responsible for the camper? *

Address *

Phone Number: *

Work Phone Number: *

Mobile Phone Number: *

Parent Email Address: *

Medical Plan/Insurance: *

Emergency Contact: *

Work Phone Number: *

Mobile Phone Number: *

Please list any Medical Conditions, Allergies, Emotional/Behavioral issues that the staff should know about? *

Please list any daily medications dosage, schedule that we need to dispense: *

Do you need to apply for a full or partial scholarship?

If yes, then for how much? *

What can you afford to pay?  *

Annual Income: *

Can you help by bringing water & snacks?

CAMPER INFO:   What is the week of camp you would like to apply for? *

Have you stayed somewhere overnight before? *

How did you hear about us? *

Please tell us your T-shirt size: specify adult or youth *

Instrument of choice (includes voice): *

Have you taken any music lessons? Please list all *

Do you write (songs, poetry, keep a journal)? *

Favorite type(s) of music: *

Favorite 3 artists: *

Please tell us why you want to attend this camp: *

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Girlz Rhythm n' Rock Camp