Girls Rock Application GRA 2021 Virtual Programs Application 1 Program Session2 Camper Information3 Demographic Information4 Preferred Camp Instrument5 Workshops6 Express Yourself!7 Emergency Contacts8 Face Mask Size9 Lunch10 Application Checklist11 Thank you for your interest in Girls Rock Austin's Programs. We are looking forward to receiving your Program application. Applications for GRA Virtual Summer 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. Tuition Payment Deadlines: GRA After School Sessions payment due by March 25th, 2021 GRA Rock Retreat payment due by April 15th, 2021 GRA Virtual Camp, Session 1 payment due by June 1st, 2021 GRA Virtual Camp, Session 2 payment due by June 15th, 2021 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. All programs will still include live instrument instructions, collaborative workshops and a livestream showcase at the end of each session. You may send application via email or mail. Applications require a $10 non-refundable processing fee. Tuition can be paid as soon as the camper is accepted. Be sure to note the payment deadlines for each session. If you need to make payment arrangements, 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 After School: Open to ages 8-17 ($400, Thursdays, starting March 25th) GRA Rock Retreat 48 Hour Songwriting Challenge For Adults 18+($200, April 24th-25th, Song Showcase May 8th) GRA Virtual Camp Session 1: Open to ages 8-17 ($475, July 12th-16th, showcase Saturday, July 17th) GRA Virtual Camp Session 2: Open to ages 8-17 ($475, July 19th-23rd, Showcase Saturday, July 24th) Does the camper own or have access to a personal device to use for camp, such as a computer, laptop, tablet or cell phone?*YesNo Name 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, where, and what instrument(s) did you play at a previous Girls Rock Camp?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* T-shirt sizes*Youth XSYouth SYouth MYouth LAdult SAdult MAdult LAdult XLAdult XXL Rock Camp does not provide lunch for campers. Campers need to bring lunch each day. We cannot provide refrigeration or re-heating for lunches. However, if the child is eligible for free lunch at school, and would like free lunch at camp, please check the appropriate box on the financial aid application and we will make arrangements for lunch to be provided for them. 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 Girls Rock Camp Austin summer session, whether or not resulting from negligence or misconduct of Girls Rock Camp, 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 LIABILTY 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 DISABILTY, OR PROPERTY DAMAGE that may arise from any transportation provided to or for my child during this year’s summer session of Girls Rock Camp Austin by any agent, employee, volunteer, affiliate or Board Member of Girls Rock Camp Austin and 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 Camp 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