GRA Virtual Program Application GRA 2021 Virtual Programs Application 1 Program Session2 Camper Information3 Demographic Information4 Preferred Camp Instrument5 Workshops6 Express Yourself!7 Emergency Contacts8 Face Mask Size Thank you for your interest in Girls Rock Austin's Programs. We are looking forward to receiving your Program application. Applications for GRA Virtual Camps are NOT COMPLETE and will NOT BE CONSIDERED until all materials (Express Yourself Pieces, Letters, and Application Fees) are received. Please fill out the Financial Aid applications if a reduced tuition amount is needed. Acceptance is on a first-come, first-served basis—space permitting. Some students MAY be admitted after these dates if space is still available. In order to continue to ensure the safety and health of all our campers, staff and volunteers, all programs will be held virtually until further notice. The Rock-A-Rama After School program will run for 10 weeks every Tuesday starting September 14th through November 16th. All programs will still include live instrument instructions, collaborative workshops and a music video premier at the end of the program on Tuesday, November 23rd, 2021. You may send application via email or mail. Applications require a $10 non-refundable processing fee. Tuition for Rock-A-Rama After School is $750 and can be paid as soon as the camper is accepted. Be sure to note the deadline to register for GRA's Rock-A-Rama After School is Friday, September 17th, 2021. If you need to make payment arrangement, please contact Jamie Bahr at jamie@girlsrockaustin.org. If you are applying for financial aid, please be sure to include that form when you submit this application. You will be notified of your financial aid status when you are notified of acceptance. No camper will receive financial aid without submitting the financial aid form. HOW TO COMPLETE THIS APPLICATION: Ideally, the camper will fill out Sections 3-6. Please have the parent/guardian review these sections, and fill out Sections 1, 2, and 7-9. Form must be filled out in one session and will not be complete until you click 'submit' at the end. NOTE: The application form will attempt to save your status, so you don't lose your place, if you leave and return to complete it later. However we recommend you complete it all at once, if possible. Please note that with every application we require an 'express yourself' piece. We want to know more about our campers and why you want to attend rock camp. This will help us when making decisions regarding their band placement and which workshops they'll attend. Which GRA Program would you like to register for? GRA's Rock-A-Rama After School: Open to ages 10-17 ($300, Sept. 14th-November 16th, Premier Tues. November 23rd) Does the camper own or have access to a personal device to use for camp, such as a computer, laptop, tablet or cell phone?*YesNoDoes the camper own or have access to a personal device to use for camp, such as a computer, laptop, tablet or cell phone?*YesNoDoes the camper own or have access to a musical instrument? If no, one will be provided.*YesNoName of Person filling out this application* First Last Your Pronouns*She/HerThey/ThemHe/HimCamper Name* First Last Camper's Pronouns*She/HerThey/ThemHe/HimCamper's Date of Birth* Age*At time of campHome Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Is your mailing address different?* No Yes Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country If different than home addressName of Parent/Guardian (If under the age of 18)* First Last Primary Phone*Secondary PhoneEmail* How did you hear about Girls Rock Camp Austin?What school does the camper currently attend?Have you or the camper attended any GRA Programs before?*YesNoWhen and what instrument(s) did you play during previous GRA experiences?What ethnicity/ethnicities do you consider yourself?Select all that apply to you. (This question is for reporting purposes only and will not impact your acceptance to camp.) White/Caucasian Latinx Asian African American Native American Native Hawaiian or Pacific Islander Other Other ethnicity Please be sure to let camper answer sections 4 and 5, as it is hard for us to accommodate requests to switch instruments once camp has started. Please mark “1” by your first choice and “2” by your second choiceGuitarKeyboardsBassDrumsVocalsWhat is your experience, if any, with your instrument of choice?Name 3 songs you can play on your instrument of choice (if possible)Name a few of your favorite bandsWe love beginners! If you are a beginner, please tell us why you chose your instrument of choice.Are you left handed or right handed?*RightLeftIf you are a returning camper, can you please tell us something you would like to do differently this year? Older and returning campers will have the choice to get in-depth and work the entire week on one topic of their choosing. Please mark “1” by your first choice and “2” by your second choice, and so on. All new (non-returning) campers age 8-10 will be placed in the Electric Youth workshop. Workshops subject to change/based on availability.Music CriticismPlease enter a value between 1 and 7.RecordingPlease enter a value between 1 and 7.DJ skillsPlease enter a value between 1 and 7.Self-CarePlease enter a value between 1 and 7.Healthy Communication/Healthy RelationshipsPlease enter a value between 1 and 7.Music TechPlease enter a value between 1 and 7.Electric YouthPlease enter a value between 1 and 7. (Games and activities for campers, mandatory for ages 8 to 11)If you are an older or a returning camper, please tell us why you chose the above workshop(s). The Express Yourself Piece is only a requirement for the GRA Virtual Camps. We want to know more about you, why you want to attend rock camp and what music means to you. There are a million ways to express yourself: write a poem, a story, or a letter; make a collage; draw a picture; take pictures; make a video; record a song; et cetera. Please know that these pieces may not be returned to you, so send us something we can keep. Also include a letter with your piece, telling us why you want to come to camp. Please make sure your piece is no bigger than 8.5x11 and must fit in a #10 envelope.How do you want to submit your personal expression sample?*I will upload my art/poem/picture right now.I will send it in by mail. Please make sure your piece fits in a #10 envelope.I'm registering for a program that does not require an expression piece.How do you want to submit your letter?I will upload my letter right now.I will send it in by mail.I am registering for a GRA Program that doesn't require a letter.Please send your example of personal expression and/or letter to: Girls Rock Camp Austin Application Department PO Box 300987 Austin, TX 78703 Personal Expression file*Please upload your artwork, poem, etc... here.Letter* (Sections 7-9 to be completed by parent/guardian.)Contact Name 1* First Last Relationship to CamperPrimary Phone*Secondary PhoneContact Name 2 First Last Relationship to CamperPrimary PhoneSecondary PhoneThe following information is very important, as it helps us provide the best care and supervision we can. All medical/behavioral information will be kept confidential, and shared only with camp nurses, counselors, and staff as necessary to provide proper care. Please include any medications the camper is taking.Does the camper have any medical conditions or allergies?*YesNoPlease list the medical conditions / allergies*So that we may best serve your child, please let us know of any specific needs she may have in any emotional, behavioral, social, or learning areas*If none, please type, "No specific needs."Is she on any medication(s) to treat any of the above-mentioned condition(s)?*YesNoPlease list medications* Girls Rock Austin Media Release Form, I, Parent/Legal Guardian of (child’s name insert below) hereby authorize Girls Rock Austin and those acting pursuant to its authority, or with its permission, to interview and/or to have photographs, audio, or audiovisual recordings made of the above-named child (“Media Images”). I further grant permission to Girls Rock Austin, its agents and assigns, to use the above-named child’s name, voice, photo, video, interview, performance and likeness for promotion of Girls Rock Austin camps, programs, and events for all forms, media and manners, including, but not limited to footage, videos, audio recording, promotional pieces, documentaries, DVDs, documentaries, news releases, photographs, website, internet mediums, marketing, advertising, trade, promotion, and exhibition for an indefinite period of time. I give unrestricted permission for images, videos, and recordings of the child to be used in print, video, digital, and internet media in whole or in part. I agree that these images and/or voice recordings may be used for a variety of purposes and that these images may be used without further notifying me. Girls Rock Austin shall own all rights, title, and interest in and to the Media Images, to be used an disposed of at the discretion of Girls Rock Austin. I acknowledge that neither the child nor I will be compensated for the use of these Media Images. In consideration for attendance at camp, campers hereby grant Girls Rock Austin a nonexclusive, perpetual, irrevocable, royalty-free, fully paid-up, worldwide license to copy, sell and distribute in any manner any songs created by campers while attending Girls Rock Austin (the “Songs”) and to incorporate the Songs, in whole or in part, into derivative works for sale and distribution without limitation. Campers retain ownership and all other rights in the Songs. I acknowledge that I have legal authority to approve this form on behalf of the minor named below.In consideration of the acceptance of my child, into the Girls Rock Camp Austin summer session this year, I hereby acknowledge and ASSUME THE RISKS BOTH KNOWN AND UNKNOWN related to my child’s participation in this activity and, to the fullest extent permitted by the law, WAIVE, RELEASE, AND DISCHARGE GIRLS ROCK CAMP AUSTIN AND GIRLS ROCK AUSTIN FROM ANY AND ALL CLAIMS FOR DAMAGES FOR DEATH, PERSONAL INJURY, PERMANENT DISABILITY OR PROPERTY DAMAGE, that I may have or my child may have, or that may subsequently accrue to or my child, as a result of my above-named child’s participation in this year’s virtual program, whether or not resulting from negligence or misconduct of Girls Rock Austin, and their agents, employees, volunteers, sponsors, affiliates, and Board Members. I further understand and agree that this GENERAL RELEASE AND WAIVER OF LIABILITY applies to the fullest extent permitted by the law to WAIVE, RELEASE, AND DISCHARGE GIRLS ROCK CAMP AUSTIN AND GIRLS ROCK AUSTIN FROM ANY AND ALL CLAIMS FOR DAMAGES FOR DEATH, PERSONAL INJURY, PERMANENT DISABILITY, OR PROPERTY DAMAGE that may arise from any transportation provided to or for my child during this year’s Girls Rock Austin programs by any agent, employee, volunteer, affiliate or Board Member of Girls Rock Austin. I acknowledge and ASSUME THE RISKS BOTH KNOWN AND UNKNOWN related to the provision of such transportation.Parent/Guardian Initials*Media and Liability Agreements In addition to this form, you'll need to send in, via mail, the following: Non-Refundable $10 application fee (unless paying online via PayPal or credit card, see below) (Check or money order payable to Girls Rock Austin. Please be sure to include in the memo “[Name of Camper], Girls Rock Camp application fee.”) The “Express Yourself” piece (unless uploaded already). Make sure your name is on it! The “Express Yourself” letter (unless uploaded already), explaining why you want to attend camp. Financial Aid Application (optional, separate form) By postal mail to: Girls Rock Austin Application Department PO Box 300897 Austin, TX 78703 All materials must be mailed to our P.O. Box, or sent via email. No drop-offs are allowed. Any photos, recorded (audio or video) and written materials created for and/or during camp are property of Girls Rock Austin and may be used for promotional purposes in the future. Girls Rock Austin does not discriminate on the basis of race, religion, national and/or ethnic origin, marital status, sexual orientation, mental or physical ability, or gender identity in the administration of any of its educational programs, admissions policies, scholarships, or other camp-related policies and programs; nor in any of its volunteer or employment-related policies or activities.How would you like to pay?*PayPal, please visit http://www.paypal.me/GirlsRockAustinGRA Website (secured through Stripe), please visit: https://www.girlsrockaustin.org/donate/Mail: GRA, PO Box 300897, Austin TX 78703 GRA 2021 Virtual Camp ApplicationDownload Español GRA 2021 Solicitud de Campamento VirtualDownload