Music Inside Out Day Camp Nomination Form


Music Inside Out Day Camp is a one-week experience featuring artistic expression and restorative practices for children ages 10-13 whose lives have been impacted by familial incarceration and possible foster care. We are looking for 10 children in the Charlottesville community who would benefit from opportunities for personal growth, improved self-esteem, and practicing solution-focused communication. Thank you for your interest in helping CHC make a difference in the lives of children and families in Central Virginia! For more information, check out our website here.
Email *
Your Name *
Your Organization or School (please provide the name and address of the organization or school)  *
Your Role *
Your Phone Number *
Your Email Address *
Your Nominee's Name *
How do you know the nominee? *
Please complete the following phrase: 

I nominate this young person for Music Inside Out Day Camp because...
 *
A copy of your responses will be emailed to .
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