MONCTON GIRLS+ ROCK CAMP '23 REGISTRATION
2023 CAMP DETAILS:

WHO: The camp welcomes girls, transgender, and gender diverse youth, ages 11-17. Beginners and experienced musicians welcome (instruments will be provided)!

WHEN: July 10-14, 9AM-5PM, with a final showcase for family and friends on July 14 from 7:00-9:00PM. Please note: camp will wrap up at 3PM on July 14th for showcase preparation.

WHERE: Lou MacNarin Elementary School, 555 Gauvin Rd, Dieppe, NB.

COST: $250 (If cost is a barrier to participation, please contact us by email to discuss options before registering).

To register, please complete the form below:
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Email *
STUDENT INFORMATION
Full Name: *
Preferred Name: *
Pronouns (check all that apply): *
Required
Date of Birth: *
MM
/
DD
/
YYYY
Language(s): *
Required
Does any of the following describe you? (select all that apply)
Phone Number: *
Street Number/Name: *
City/Town: *
Email: *
STUDENT HEALTH INFORMATION
Any information requested below is asked solely to help us take the best possible care of your youth; it is held in the strictest confidence and will only be shared with those who need to know (directors/facilitators).  
Does the student have any medical conditions or allergies that we should be aware of? Yes or no, if yes please list: *
Does the student take any medications that we should be aware of (EpiPen, Insulin, etc.)? Yes or no. If yes, please list/describe. *
Does the student have any special needs (emotional, behavioural, learning, developmental, etc.)? Yes or no. If yes, please list/describe: *
CAMPER ROCK N' ROLL HISTORY
Have you had any music lessons before? Yes or No? If yes, which instruments and for how long? Please describe. *
Are you right- or left-handed? *
Each student will be assigned to learn and play one rock instrument for the week (either guitar, bass, drums, keyboard, or vocals). Which instrument(s) would you like to play most during the camp? Rank each instrument in order of preference. (*Please choose a different rank for each instrument*). *
1st Choice
2nd Choice
3rd Choice
4th Choice
5th Choice
6th Choice
Guitar
Bass
Drums
Keyboards
Vocals
Wild Child (Up for trying anything!)
Student t-shirt size? (Choose between ladies or mens sizing).
Small
Med
Large
X Large
2XL
Ladies
Mens
Clear selection
PARENT/GUARDIAN INFOMATION
Full Name of Parent/Guardian: *
Parent/Guardian Phone Number: *
Parent/Guardian Email: *
What is the best way to contact you with general information about the camp (non-emergencies only).   *
EMERGENCY CONTACT INFORMATION (someone other than the parent/guardian named above in case they cannot be reached) :
Name of emergency contact: *
Relationship to the student: *
Phone number of emergency contact: *
Email of emergency contact: *
MEDIA PERMISSION
During the camp, we will take pictures and video of students during camp activities. Recordings and photos are often used to promote the camp or our other programs/events. 
Do you consent to the Greater Moncton Girls+ Rock Inc. using audio/visual recordings/photos of your youth on social media, our website and for promotional purposes? *
REGISTRATION FEE PAYMENT
Once you complete this form, please send an email money transfer to monctongirlsrock@gmail.com for the fee of $250 to confirm registration. If you would like to pay using cash or check, please email us to arrange after filling out this form. Registration will be confirmed once payment is received, unless otherwise arranged.
How will you be paying the camp registration fee? *
For email money transfers, from which bank and under whose name will you send your payment?
How did you hear about the Moncton Girls+ Rock Camp? *
Required
What are you looking forward to most about coming to Girls+ Rock Camp?
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Any additional Info/Comments/Questions?
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