Membership Registration

 

Please complete the form below. Someone will contact you regarding payment after you submit the form.

Camper Information
Name *
Name
Address
Address
Phone
Phone
Parent/Guardian Information
Name
Name
Address
Address
Phone
Phone
Camp Information
Which camp are you applying for?
Are there other siblings in the camp
Is the camper interested in being a mentor?
Mentors are returning campers ages 14-16 who are interested in being a liaison between new campers/younger campers and counselors. Mentors will NOT be eligible for the camp bands but, are still eligible for all other performance opportunities throughout the year.
Instrument Information
First Instrument Choice
Second Instrument Choice
Third Instrument Choice
Will the camper bring their own instrument?
Additional Information
Tshirt Size
Race/Ethnic Identity
Creating a group of campers that reflects the diversity of our communities is a camp priority. In addition, some of our funders require the racial/ethnic and economic composition of our camp population to be documented. Providing the following information will help us meet our diversity goals and help us continue to receive funding for future camp sessions. Please check ANY AND ALL that apply OR skip this question and mark other.
How will you be paying membership dues?
Please pay by check or via PayPal (See details below.)

If paying via PayPal:

1.  Click here.
2. Sign into your PayPal account
3. Send payment to dorijansma@gmail.com

If paying by check, please remit to:

Girls Rock Des Moines
303 East Court Ave
Des Moines, Iowa, 50309