Girls Rock Columbia 2024 Camper Registration
July 22-26, Showcase July 27
Name of authorized adult completing this form
*
First Name
Last Name
Your email address
*
example@example.com
Your relationship to camper
*
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Camper Information
Camper's full name
*
First Name
Last Name
For 2024 camp, we will only be serving campers ages 12-17.
Date of birth (mm/dd/yy)
*
-
Month
-
Day
Year
Date
Camper's gender pronouns [Gender pronouns are the pronouns that your camper would like others to use when talking about that individual. For example: she/her/hers, she/they, they/them/theirs, he/his/him, etc]
*
Camper's Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this a good mailing address for camper?
*
Yes
No
Mailing address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of camper's school
*
This school is
*
public
private
parochial
alternative/homeschool
public charter
Other
Name(s) of any siblings applying to GRC this year
Has your camper attended Girls Rock Columbia before?
*
yes
no
Which past years did your camper attend?
2015
2016
2017
2018
2019
2020
2021
2022
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Parent/guardian/emergency contact information
Your full name
*
First Name
Last Name
Do you live at same address as camper?
*
Yes
No
Your address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Lives with camper
full-time
part-time
does not live with camper
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Do you wish to list a second parent/guardian?
Yes
No
Parent/guardian 2 Full Name
First Name
Last Name
Relationship to camper
Lives with camper
full-time
part-time
does not live with camper
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email address
example@example.com
Parent/guardian 2 address (if different than camper primary address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Camper Information
Are there any medical conditions or allergies of which we should be aware?
*
Yes
No
Please list any medical conditions or allergies.
*
Is the camper taking any medications?
*
Yes
No
Please list any medications the camper is taking and if any of them need to be stored daily at camp:
*
Does the camper have any dietary restrictions or food allergies?
*
Yes
No
Please list any dietary restrictions or food allergies.
*
Are there any emotional or behavioral needs that we should be sensitive to so that we can provide a safe environment to enjoy summer camp? (please note, providing this information will not prevent your camper from being admitted to GRC!)
*
Are there any significant circumstances or family situations affecting your camper that you would like to let us know about (for example: recent move or parents going through a divorce)?
*
If your camper needs translation/interpretation assistance, please indicate here
Racial/ethnic identity (optional)
Creating a group of campers that reflects the diversity of Columbia communities is a camp priority. Providing the following information will help us make sure we're doing that.
Please check any/all identities that apply to your camper or write in your identity below
Asian/Pacific Islander
Chican@/Latin@
Native American
Black/African-American/Carribean-American
Middle Eastern/Arab-American
White/European-American
Other
Camp questions
Are there any campers you want to be placed in a band with?
How did you hear about Girls Rock Columbia? Please be specific (names, media, online source, places, etc.)
*
Camper T-shirt size
*
youth S
youth M
youth L
adult S
adult M
adult L
adult XL
adult XXL
adult XXXL
adult 4XL
adult 5XL
Rank your picks for camp instrument - Tap and slide to reorder instrument choices from first pick (1) to last pick(4)
*
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Tuition Information
Full camp tuition is $350.00 per camper for the entire week. This fee covers many expenses to provide an exceptional experience for the campers, including musical instrument care, workshop supplies, camp shirts, venue costs, and camper lunches. We sincerely seek to support each child who wants to participate in Girls Rock Columbia and do not want camp fees to prevent any child from attending camp. To better serve a diverse economic population, we use an income-based sliding scale for tuition. Sliding scale enables folks to determine what best fits their budget. That being said, know that your payment for GRC camp is subsidizing the cost in all its parts. We ask that you take into consideration both your financial needs and the financial needs of Girls Rock Columbia.The below chart is a suggested guideline for tuition payment. There is no minimum amount you can request for tuition. Please write the dollar amount you are able to contribute for tuition below. You will receive an invoice with your camper’s acceptance letter and can pay by sending a check to 1013 Duke Avenue, Columbia, SC 29203 or via PayPal by visiting www.girlsrockcolumbia.org, clicking the 'Donate' button, and including your camper's name in the note. The first half of tuition is due June 1, and the balance is due July 1.
My 2024 tuition pledge is:
*
Would you be willing to contribute tuition assistance to help a camper who is unable to pay the full amount?
Yes
Not at this time
How much are you willing to contribute? We greatly appreciate any amount you are willing to invest in camp! If you have any questions about contributions to Girls Rock Columbia, please contact us at hello@girlsrockcolumbia.org!
Media Release Form
I authorize Girls Rock Columbia’s documentation team to record and edit into Footage/Video/Promotional Pieces/documentaries for organizational use, my child's name, text, likeness, voice, interview and performance. Girls Rock Columbia shall own all of the rights, title(s), and interest(s) in and to the program(s), including the recording(s), to be used and disposed of at the discretion of the Girls Rock Columbia
*
yes
no
I authorize any media outlet authorized by Girls Rock Columbia to use my child's name, text, likeness, voice, interview and performance in any article, video, or other media format.
*
yes
no
For campers!
Girls Rock Columbia 2024 TEEN Camper Application
Camp this year will take place at Columbia College the week of July 22-26, and the showcase will be July 27 at (location and time TBD)!
Do you have any musical experience? If so, how much and on what instruments?
*
What are some of your favorite musicians/bands/musical groups?
*
What sort of hobbies do you have?
*
What's your favorite thing about yourself?
*
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