Camper Application for Rock The Rez 🎸🥁🎤🎶

Camper Application for Rock The Rez
Welcome to our 10th Annual Rock The Rez Summer Camp application!!! Our aim at Rock The Rez is to empower girls, transgender, Two-Spirit, and gender diverse youth to build self-esteem and find their voices through unique programming that combines music education and performance, empowerment and social justice workshops, creative collaboration, positive role models and leadership skill building.

Rapid City Camp: June 22nd-26th, Showcase 27th
Pine Ridge Camp: June 29th-July 3rd, Showcase July 3rd
Rosebud Camp: July 6th-10th, Showcase July 10th
Twin Cities Camp: July 27th-31st, Recording & Showcase August 1st
Denver Camp: August 6th-9th, Performance August 9th
Bemidji Camp: August 17th-21st, Showcase August 21st

Camp hours: 8:00am-4:00pm Monday- Friday

Tuition:
There is no required tuition for camp, however, we do suggest families make a donation if you're able. This helps us to continue hosting camp each year! We estimate it costs about $200 per camper.
Two meals are provided daily, breakfast and lunch. We also will provide an afternoon snack.

Transportation:
Please see the liability section of the application to mark if your camper will need transportation to or from camp.

***The final question of this application is "Why do you want to participate in Rock The Rez camp?" We would encourage you to sit down with your camper and have them submit their own answer. Answers to this question are looked at for thoughtfulness and creativity. ***
Camper Full Name*

First NameLast Name
Camper's Gender Pronouns
They/Them, She/Her, He/Him, etc.
Camper Age*
As of September 2026
Camper Email Address
example@example.com
Camper Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Full Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Email Address*
example@example.com
Facebook Name
Best way to contact you during the day

CallTextEmailFacebookOther
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Camper*
Does the camper have any allergies or medical conditions we should know about?
Which camp will your camper attend?

Rapid City (June 22-26, Showcase June 27)Pine Ridge (June 29-July 3rd, Showcase July 3rd)Rosebud (July 6-10, Showcase July 10)Twin Cities (July 27-31, Recording at Pachyderm Studios & Showcase Aug. 1)Denver (August 6-9, Showcase Aug. 9)Bemidji (August 17-21, Showcase August 21)
Preferred Instrument (Please choose 2)*

GuitarBassDrumsVocalsKeyboardOther
Which instrument is their first choice and does the camper have any experience with these instruments? Please explain
Does your camper need transportation to and from camp?*

YesNo
If you marked yes, will your camper be at the address provided? If no, please list the address for pick-up/drop-off and any additional directions needed. (Please note, you may be contacted prior to camp to coordinate a more central pick-up/drop-off point)
T-shirt Size*
I give Rock The Rez permission to photograph, videotape, record or interview my child and to publish on our organization's social media or website

YesNo
I give Rock The Rez the permission to quote my child

YesNo
My camper will need transportation to and from camp, I give Rock The Rez permission to transport my child.

YesNo
Why do you want to attend Rock The Rez?
Donation Amount

prevnext( X )
USDDescription
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info

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