G.I.R.L.S. ROCK SACRAMENTO

Camper's Full Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Parent/Guardian's Name *

First Name

Last Name

Parent/Guardian Phone *

(###)

###

####

Address *

Camper must reside within the Del Paso Heights community.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name *

Adult other than parent/guardian listed above

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Does your camper sing? *

Check all that apply!

Yes! They sing lead!

Yes! They can sing backup!

No, they would rather not sing.

Which of the following best represents your camper's racial or ethnic heritage? Choose all that apply. *

Native American or Alaskan Native

Black, Afro-Caribbean, or African American

Latinx or Hispanic American

Asian or Pacific Islander

South Asian or Indian American

Middle Eastern or Arab American

Non-Hispanic White or Euro-American

Other

With which of the following does your camper identify? *

We use this information for grant reporting purposes. Thank you for your help!

LGBTQ2S+

Female

Male

Non-binary

Transgender

Immigrant

Refugee

Person with a Disability

Justice Impacted Person

Other