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Girls Rock Vegas Summer Camp 2010

What:
Girls Rock Vegas Summer Camp is a five-day hands-on music experience where girls will learn to play an
instrument, form a band, and write an original song which they will play at our showcase concert. They will
receive over 20 hours of small group music instruction from licensed teachers and music professionals.

Who:
Any girl between the ages of 9 and 17 may apply for camp. No musical experience is necessary, although
experienced musicians are welcome to apply!

When:
Monday June 14th through Friday June 18th. Camp is held each day from 9:00am until 3:00pm.
The showcase concert will take place on Saturday, June 19th. Showcase location and time TBA.

Where:
Elaine Wynn Elementary School, located at 5655 Edna Avenue, Las Vegas, NV 89146.
Closest cross streets are Sahara and Jones.

Fees:
Application fee: $10 (non-refundable) This fee will be applied towards your tuition.
Tuition: $225 (payable with cash, check, money order, or online via PayPal), due Friday June 4th, 2010.
Girls Rock Vegas seeks to offer needs-based financial aid (up to 75% of tuition costs) to all campers who need it. However,
financial aid is dependent on limited funding sources, and unfortunately, may not be available to all campers. All campers
who are in need are strongly encouraged to apply for financial aid.

Lunch:
Girls Rock Vegas cannot provide lunch for campers. Each camper needs to bring lunch and water each day.
However, if you are eligible for free lunch at school, and would like free lunch at camp, please check the box on the
financial aid application and we will do our best to make arrangements for lunch to be provided.

Instrument Selection:
You can choose to study guitar, bass, drums, keyboard, or vocals. Because we must acquire the instruments and
gear in advance, you cannot change your selection after you send in your application, and you cannot change
during the camp session.

Musical Instruments:
Girls Rock Vegas will loan you an instrument during the week of camp for use during the camp day. If you have
your own guitar or bass, feel free to bring it. Please note that Girls Rock Vegas cannot accept liability for
personal instruments.

For more information, visit:


www.girlsrockvegas.org
This project is funded, in part, by a grant from the Nevada Arts
Council, a division of the Department of Cultural Affairs, and the
National Endowment for the Arts, a federal agency.
Full Name of Camper: _______________________________ Nickname: ________________

General Information
Date of Birth: ____________ Age on June 14, 2010:_________

Home Address: _____________________________ City: ______________ State: ____ Zip: _____

Mailing Address (if different): ________________________ City: _______ State: ____ Zip: _____

Camper’s Email Address: _____________________________________________

Name of Parent/Guardian: ____________________________

Parent/Guardian’s Email Address: _____________________________________________

Home Phone: _____ - _____ - _________ Cell Phone: _____ - _____ - _________

Work Phone: _____ - _____ - _________ Camper’s Phone: _____ - _____ - _________

Emergency Contacts

Name: _______________________________ Relationship to Camper: _____________________

Home Phone: _____ - _____ - _________ Cell Phone: _____ - _____ - _________

Work Phone: _____ - _____ - _________

Name: _______________________________ Relationship to Camper: _____________________

Home Phone: _____ - _____ - _________ Cell Phone: _____ - _____ - _________

Work Phone: _____ - _____ - _________


Questions for Campers
How did you hear about our camp? ________________________________________________
Where did you get an application? _________________________________________________
What is the name of your school? __________________________________________________
What music programs do you participate in at your school? _____________________________

Indicate which instruments you are interested in learning to play.


Guitar Bass Guitar Keyboard Drumset Vocals

The guitar has six The bass guitar has The keyboard plays The drumset plays the The vocalist sings and
strings and plays the four strings and plays the melody and/or beat of the song and helps write the lyrics
melody and/or chords the low notes in the chords (more than helps the other band (words) in a song.
(more than one note song. The bass helps one note at once). members play in
at once). keep the rhythm. rhythm.

FIRST CHOICE (circle one):


Guitar Bass Guitar Keyboards Drumset Vocals

SECOND CHOICE (circle one):


Guitar Bass Guitar Keyboards Drumset Vocals

THIRD CHOICE (circle one):


Guitar Bass Guitar Keyboards Drumset Vocals

Rate your experience on the following instruments. Remember that it does not matter if you
are a total beginner on every instrument. This information is only for our planning purposes.
1 = Advanced Player (I’ve been playing for awhile)
2 = Moderate Player (I have some skills on this instrument)
3 = Total Beginner (I’ve never touched this instrument before, and that’s okay!)
____ Guitar ____Bass Guitar ____Keyboard ____Drumset ____Vocals
What other instruments do you play? _____________________
Do you have your own instrument that you want to bring to camp? ___Yes ___No
If so, what instrument? ______________________
Note: Unfortunately, Girls Rock Vegas cannot be liable for personal instruments.
T-Shirt Size CHILD SIZES: ___size 6/8 ___size 10/12 ___size 14/16
or ADULT SIZES: ___S ___M ___L ___XL ___XXL
Campers: Express Yourself!
Use this page to tell us why you want to come to Girls Rock Vegas Summer Camp! You can
write a paragraph, write your biography, write a poem, draw a picture, etc… Just express
yourself and tell us why you want to rock out with us this summer!
Questions for Parents
CONFIDENTIAL INFORMATION
Medical and Behavior Issues:
Does your camper have any allergies, medical, or emotional/behavioral issues the staff should
know about? This is important to assist us in providing the best care and supervision we can.
___YES ___NO If yes, please explain:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Please list any medications that must be distributed at camp. This information is only for the
camp nurse and necessary staff. ____________________________________________________

The following information is optional and gathered solely for the purpose of our funding and statistical records.

Racial/Ethnic Identity (OPTIONAL): Please check all that apply.


Hispanic Asian/Pacific Islander
Native American White/European
Middle Eastern Black/African American
Other:

Estimated Household Monthly Income (OPTIONAL): $____________________

NOTE: If you would like to apply for FINANCIAL AID to assist with tuition to our camp, please fill
out the additional Financial Aid Form. All information that you give is strictly confidential.

Language Needs: Do you speak another language besides English at home? If so, please
indicate if you would like translated materials (if possible) or an interpreter, and in which
language? ___________________________________________________________________
Se necesita ayuda con traducciones y materials en español? Por favor, indica acqui y si hay otros
idiomas que hablan en casa: _______________________________________________________

I agree to drop my child off at Wynn Elementary no earlier than 8:50am and pick
my child up at 3:00pm during the each camp day. (Parent Signature Required)
X_____________________________________
Financial Aid Application
DUE: Tuesday, May 25th
Girls Rock Vegas seeks to offer financial aid to all campers who may otherwise not be able to attend our camp.
However, financial aid depends on our limited funding sources, and unfortunately, may not be available to all
campers. Please know that we will thoroughly consider the information you provide below in a respectful and
confidential manner, and will use it to the best of our ability toward the goal of eliminating financial barriers that
prevent girls from attending our camp.

FINANCIAL AID GUIDELINES


Household Annual income under $30,000
Most of our financial aid goes to campers from households with a total annual income of less than $30,000. Please let us
know how much you can afford to pay and we will do our best to accommodate, depending on our funding resources.
Household Annual income between $30,000 and $60,000
Some partial financial aid goes to girls from households with a total annual income between $30,000 and $60,000. You may
request financial aid if needed.
Household Annual income above $60,000
Girls Rock Vegas will consider financial aid for households with a total income of greater than $60,000 only in extenuating
circumstances, such as medical hardship. We cannot grant financial aid due to the camper being enrolled in multiple
summer programs, or other situations involving elective activities. However, if you feel you need financial assistance, please
submit a financial aid form with an explanation, and we will review it.

GENERAL INFORMATION
Name of Camper: _____________________________________________________

Camper’s Email Address: _____________________________________________

Name of Parent/Guardian: ____________________________

Parent/Guardian’s Email Address: _____________________________________________

ECONOMIC INFORMATION
Estimated Household Monthly Income: $_________________

Is your camper eligible for free/reduced lunch at school? ___Yes ___No ___Don’t Know

How will your camper be traveling to and from camp? ______________________________________

Please use the space below to elaborate on any other aspects of your financial situation that you feel we should
consider in determining eligibility for financial aid. Feel free to use the back of this form if you need more space.

____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Application Checklist
This application must be postmarked by Tuesday, May 25th, 2010.

Your application packet must include:


 Completed Application
 “Express Yourself” Page
 Completed Financial Aid Form (optional)
 Non-refundable $10 application fee
(This fee will go towards your tuition). Please do not send money with this application. We
will send payment information with your acceptance packet. Payment is due by Thursday,
June 3rd.
Please send your completed materials to:
Girls Rock Vegas
Attn: Camper Application
P.O. Box 80274
Las Vegas, NV 89180
You may email your completed application to info@girlsrockvegas.org .
(or return to ________ in room _____)
If you have any questions, please email us at info@girlsrockvegas.org .
We will mail acceptance letters by Friday, May 28th, 2010.

House of Guitars Salt Lake


Super Pawn This project is funded, in part, by a grant
Wynn Elementary School from the Nevada Arts Council, a division of
Roundy Elementary School the Department of Cultural Affairs, and the
Rayna Montez National Endowment for the Arts, a federal
The Dollyrots
agency.
Girls Rock Camp Alliance