You Rock! 2026 Camp Application Form
Please fill this form out completely to be register for camp. Incomplete applications will not be accepted.
Camper Info
Name
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Preferred Name
*
Birthdate
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Month
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Day
Year
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Email
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Phone number
*
Primary Language
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English
Spanish
Other
School Attending
Grade Level Next Year
*
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Parent or Guardian Info
First and Last Name
*
Address
*
Phone Number
*
Email
*
I am interested in applying for a scholarship
*
Yes
No
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The Fun Stuff!
Tell us about your instrument or production preferences!
I prefer to not perform and concentrate on production.
Yep! That's me
Nope. I want to perform.
I want to perform - and here are my top instrument choices, in order of preference.
Instrument Choice #1
*
Please Select
Bass
Guitar
Drums
Keyboard
Vocals
Instrument Choice #2
*
Please Select
Bass
Guitar
Drums
Keyboard
Vocals
Instrument Choice #3
*
Please Select
Bass
Guitar
Drums
Keyboard
Vocals
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Back to the boring stuff...
Household info
*
Both parents
Mother only
Father only
Grandparents
Foster Home
Other
Household Size
*
Is Parent/Guardian active Military?
*
Yes
No
If Yes, Which Branch?
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Emergency Contact Info - Must Have 2
Emergency Contact 1: First and Last Name
*
Emergency Contact 1: Phone Number (with area code)
*
Emergency Contact 1: Address
*
Emergency Contact1: Email
*
Emergency Contact 2: First and Last Name
*
Emergency Contact 2: Phone Number (with area code)
*
Emergency Contact 2: Address
*
Emergency Contact 2: Email Address
*
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Medical Info
Insurance Company (if none, please put NA)
*
Insurance Policy Number (If none, please put NA)
*
Medical Problems, Disabilities
*
Allergies
*
Medications
*
Physician
*
Physician Phone Number
*
Please read and agree to:
*
I agree my child will abide by the camp rules while on premises
I give permission for my child to use computers with internet access. While precautions are being taken, it is possible they may access inappropriate sites. You Rock! Camp will have rules and consequences at the camp for such behavior, however, we will not be responsible for the consequences of such access.
I give permission for You Rock! Camp to survey my child about their experience, behaviors, skills and attitudes using survey instruments.
I understand You Rock! Camp is not responsible for lost or stolen items.
I understand that my child must be picked up before or at closing time. You Rock! Camp provides no supervision after closing. Campers not picked up at the close of camp are the guardian's responsibility and the proper authorities will be called.
I will not hold You Rock! Camp responsible in case of injury from my child's activities in the Camp and I give consent for him/her to be given emergency treatment by a physician or hospital in case of an accident.
I give permission to use pictures, audio, videos, electronic images and/or other works of my child in club-related publications, advertisements, media files, internet website, or any other photo or media outlet
PLEASE TYPE YOUR NAME BELOW, AS GUARDIAN, IN AGREEMENT
*
Date
*
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Month
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Day
Year
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Submit
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