CAMP APPLICATION FORM

GIRLS ROCK! WA JANUARY 2019 CAMP IS NOW FULL.

Please fill out the following form to GO ON THE WAITING LIST FOR THE january 2019 camp.

WE WILL BE IN TOUCH TO LET YOU KNOW WHETHER ANY SPACES OPEN UP.

Applicant Name *
Applicant Name
Date of Birth
Date of Birth
Where did you find out about Girls Rock! WA? *
Please select the instrument you would most like to play on camp:
Primary Address *
Primary Address
Payment *
Please indicate which of the following applies to you. You will be invoiced upon successful application. If applying for a 1/2 scholarship we will be in touch to discuss eligibility.
Photography and Videography Permissions *
I hereby give my permission for my child to appear in still and moving images taken or recorded by or on behalf of Girls Rock! WA and WAM. I give permission for these images to be used in any or all of the promotional and advertising material of Girls Rock! WA and WAM including online media, social media, print, newspaper, video, public displays television and electronic means of communication and in any edited form. I waive any rights and claims, present and future, to any fees or royalties or other benefits whatsoever for or in connection with the use of the images.
Creative Material Release *
I hereby give my permission for any and all creative material (including songs) made by my child during Girls Rock! WA camp to be used in any or all of the promotional and advertising material of Girls Rock! WA and WAM.