Summer Camp 2022 Camper Application

BGRC Summer Camp 2022 Camper Application
This application will take about 10-15 minutes to complete in most cases.

Your application will not be received until you select "Submit" at the bottom and see the confirmation message.

We ask that you answer every applicable question.
Camp Session
Please confirm the camp session(s) you are applying for.

Rock Camp, Session 1: June 20-25, 2022 Rock Camp, Session 2: June 27 - July 2, 2022
Camper Basic Information
Name

First Name Last Name
Preferred Pronouns
Age at camp
Birth Date

Month Day Year
Date
School and Grade
Rock Camper Info

Please ask your rock camper these questions so we can get a better idea of their interests and goals for camp.
Who are some of your favorite bands or musicians?
Please indicate below which instrument you would most like to play at camp.

We will do our best to give you your first choice, but to form bands we need a certain ratio of instruments. You may not get your first choice, but every instrument is awesome and we will all work together!
Guitar

1

2

3

4

5

1 is Least, 5 is Most
Bass

1

2

3

4

5

1 is Least, 5 is Most
Keyboard

1

2

3

4

5

1 is Least, 5 is Most
Drums

1

2

3

4

5

1 is Least, 5 is Most
Do you have any experience playing a musical instrument? Please note: musical experience is not required to attend Rock Camp.
Express Yourself Piece
Campers! We ask that you upload your Express Yourself Piece here. Please use any medium of your choice (i.e. poem, song, drawing, photo, video, etc.) to express to us why you want to be a part of Rock Camp.

***Your application is pending without this piece, but you can take some time on this and send it in within a couple of weeks in order to truly "Express Yourself". You can mail to P.O. Box 2031, Bellingham, WA 98225 or email to info@bgrc.org. Also, please remember to include your name on any additional materials!***
Cancel of
Camper Medical Information

Please list all known conditions so that we may accommodate your camper's needs. It is very important that all conditions are reported to us with detail. This will not affect their acceptance into camp, and will help us to provide necessary staffing and support. All information will be kept confidential and shared only with the camp staff as necessary to provide proper care for your camper.
Does your camper have any medical conditions and/or allergies?

Yes No
If yes, please list and explain all medical conditions in detail.
Is your camper on any medication to treat these conditions? If so, please list
Please note: medication cannot be administered by camp staff or volunteers.
Does your camper have any behavioral and/or emotional issues?

Yes No
If yes, please list and explain in detail.
Is your camper on any medication to treat these conditions? If so, please list.
Please note: medication cannot be administered by camp staff or volunteers.
Is there anything else we need to know about your camper in order to best accommodate their needs?
Parent/Guardian Information
Parent/Guardian Name

First Name Last Name
Parent/Guardian Pronouns
Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mailing Address (if different from home address)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Phone
Please enter a valid phone number.
What is the best way to contact you with information and/or questions?

Email Text Message Phone Call
Emergency Contacts
First Emergency Contact's Name

First Name Last Name
Relation to Camper
First Emergency Contact's Phone
Please enter a valid phone number.
First Emergency Contact's Email
example@example.com
Second Emergency Contact's Name

First Name Last Name
Relation to Camper
Second Emergency Contact's Phone
Please enter a valid phone number.
Second Emergency Contact's Email
example@example.com
Tuition Guidelines
Tuition is $350. Tuition is due upon application. If financial aid is requested, we will contact you and confirm the amount of assistance we can offer. You will be asked to make your tuition payment upon receiving confirmation of your financial aid amount.
Financial Aid Request

Partial Tuition Assistance Full Tuition Assistance
If you selected Partial Tuition Assistance please indicate how much you can pay. (Full tuition is $350).
The amount of tuition assistance that we have available is based on our fundraising campaigns and we will do our best to meet your needs. We will contact you and confirm the amount of assistance we can offer. You will be asked to make your tuition payment upon receiving confirmation of your financial aid amount.
Does your camper need free lunch at camp?

Yes No
If you are requesting free lunch at camp, does your camper have any dietary restrictions and/or food allergies?
Please use this space to write in any additional information you would like us to know regarding your request for financial aid.
Demographic Information

Frequently, we are required to report on the demographics of our camp to funders, the Girls Rock Camp Alliance, and other agencies. All statistics are reported in aggregate and anonymously. This information is very important and will not affect your camper's admittance into camp. Providing the following information will help us meet our goals. Thank you so much for your time and information!
Does your camper qualify for free or reduced lunch at school?

Free Lunch Reduced Lunch Neither
Estimated Household Annual Income
How many people live in your household?
Please list number of adults and number of children.
Please check any and all that apply to your camper.

Asian Pacific Islander Chicana/Latina/Hispanic Black/African American/Caribbean American Middle Eastern/Arab American Native American / Native Alaskan / American Indian White / Caucasian Two or more Races Other
Please upload proof of COVID-19 vaccination and booster for your camper.

Cancel of
If there is a medical reason why your camper cannot receive the COVID-19 vaccine, please explain.
Please upload proof of vaccination and booster for members of your household.

Cancel of
I acknowledge that masks will be required during camp hours and agree to wear a mask and social distance at camp.

Yes No
I acknowledge that proof of COVID-19 vaccination and/or a negative COVID-19 test result from 48 hours or less before camp is required to attend Rock Camp.

Yes No
How did you hear about us? (Both for the first time and more recently)
Be specific as possible, including names! (List friends, websites, news organizations, radio shows, etc.) We would like to know which areas of outreach are working for us, so the more detail you provide, the better!
I understand that my camp tuition is due upon receipt of the invoice from BGRC. All checks must be mailed to PO BOX 2031 Bellingham WA 98227.

Yes No
I understand that I must send in my Express Yourself piece within two weeks for my enrollment to be confirmed.

Yes No
Should be Empty:

BGRC Summer Camp 2022 Camper Application

Camp Session

Camper Basic Information

Rock Camper Info

Please indicate below which instrument you would most like to play at camp.

Express Yourself Piece

Camper Medical Information

Parent/Guardian Information

Emergency Contacts

Tuition Guidelines

Demographic Information