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.
What do you like to be called?
Would you like to tell us what personal pronouns you prefer?
Date of Birth
Date of Birth
We want to get to know you! Please tell us about yourself and a few identities that are important to you (e.g. activist, bookworm, vegan, LGBTQI+, athlete, music lover, extrovert, theatre performer, any other ways you would describe yourself).
Do you have any differences in ability and/or medical conditions that you want to let us know about? TAFE complies with the Commonwealth Disability (Access to Premises - Buildings) Standards 2010 (Premises Standards), and GR!WA is committed to accommodating any further requests for access where possible.
Why do you want to come to Girls Rock! camp? Tell us a little about what you're hoping to get out of the week. This will help us to plan something awesome for you!
Where did you find out about Girls Rock! WA?
Word of mouth (someone told me about it)
WAM e-news (WAMplifier)
Please select the instrument you would most like to play on camp:
Do you have any dietary restrictions or allergies? We will do our best to accommodate your dietary needs. (Please note that morning/afternoon tea is provided but campers bring their own lunches.)
Name of Parent/Caregiver
Contact Email for Parent/Caregiver
Emergency Phone Contact
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.
Full fee $400
Full fee + donation of 1/2 scholarship for an underprivileged student $600
1/2 Scholarship $200
WAM Member (10% discount) $360
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.