b
APPLY TO RC4G

To apply for RC4G's 2010 summer programs, just fill out the application form below
and click 'Send'. (Please make sure an adult has approved the application!)

Applications will be considered on a first-come, first-served basis. The full
registration fee is $225. Please note that we must receive a $50 deposit in order for
your application to be considered complete. (We will refund the deposit if camp is
full, or if you notify us before July 1 that you cannot attend.)

If you prefer to fill in a paper application, forms can be picked up at:

Maar's Music (360 George St. N.)
Bud's Music Center (296 Aylmer St. N.)
The Spill Coffee Bar (414 George St. N.)
Sadleir House (751 George St. N.)

Your deposit and/or completed application form can be mailed or dropped off to:

RC4G Peterborough, 762 Armour Rd., Peterborough, ON, K9H 2A1

Please make cheques payable to RC4G Peterborough.

SUBSIDIES AVAILABLE! DEADLINE EXTENDED TO JUNE 30
If the cost of attending Rock Camp appears too high, don't despair! It is our goal to
make Rock Camp accessible to all girls who want to attend. Subsidies from the City
of Peterborough are available to qualifying individuals. Contact the Recreation
Department at 705-742-7777 ext. 1827. Also, thanks to the financial support of our
community, RC4G Peterborough is able to offer registration fee reductions on a
case-by-case basis - you can apply online. The deadline for application is June 30. If
you'd like to make a donation to help other young women attend Rock Camp, please
contact us directly by phone at 705-748-4987 or by email at rc4g@sympatico.ca.
b
b
-   
RC4G 2010 Summer Programs
Online Application Form
NOTE: To avoid incomplete forms being sent to us accidentally, we have made all text areas "required" fields. This means
you must put something in each space, even if you just type "none". Otherwise, you'll get an error message.
SUMMER 2010 SESSION INFORMATION
I would like to attend:
Session 1: August 9-13 (ages 11 to 14)
 I can attend either
Session 2: August 16-20 (ages 11 to 17)
 I'm not sure, I need more information
CAMPER INFORMATION
Name:
 Age (at time of camp):
Home address:
City:
 Postal Code:
Name of parent/guardian:
Home phone:
 Work phone:
 Cell phone:
Email address (one that you check frequently):
Which is the best way to contact you?
INSTRUMENT CHOICES
Please indicate a first and second choice of instrument. We do our best to give everyone their first choice, but we need to
have a balance of instruments to make bands and instrument instruction run smoothly.
First choice?
Electric guitar
 Electric bass
 Keyboards
 Drums
Second choice?
Electric guitar
 Electric bass
 Keyboards
 Drums
Will you be bringing your own instrument to camp? (It's not necessary, but you may if you like AT YOUR OWN RISK.)
No
 Yes
 If yes, what instrument will you be bringing?
Do you require a left-handed instrument?
 Yes
 No
WHO ARE YOU, REALLY?
We'd love to know more about you! Please give us a brief description of your interest in music, who you like to listen to,
and what you hope to get out of camp.
SAFETY INFORMATION
Please let us know if the camper has any medical, emotional or behavioural conditions or medications that our staff should
know about.
EMERGENCY CONTACTS
First contact name:
 Contact phone:
Relationship to camper:
Second contact name:
 Contact phone:
Relationship to camper:
PICK-UP INFORMATION
Campers will be released at the end of the day only to authorized individuals. Please list the names of those who may pick up
this camper. (If the camper is allowed to leave unaccompanied, please send a note on the first day of camp.)
PUBLICITY WAIVER
I give permission to RC4G Peterborough to use photos, video or sound recordings of this camper for documentation or
promotional purposes.
I DO NOT give permission to RC4G Peterborough to use photos, video or sound recordings of this camper for
documentation or promotional purposes.
NEED MORE INFORMATION?
If you need more information or have questions, let us know. We'll get back to you as quickly as possible. (Or call us at
705-748-4987.)