Girls Rock Application - Girls Rock Austin

Name of Person filling out this application*

First Last

Your Pronouns*

Camper Name*

First Last

Camper's Pronouns*

Camper's Date of Birth*

Age*

At time of camp

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is your mailing address different?*

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

If different than home address

Name of Parent/Guardian (If under the age of 18)*

First Last

Primary Phone*

Secondary Phone

Email*