1. ABOUT THE CAMPER
First Name:
Last Name:
Date of Birth:
Age (at time of camp)
How did you hear about Girls Rock Philly?
Does the camper have any medical conditions or allergies?	Yes No If yes, please list:
Is the camper on any medication to treat these conditions?	Yes No If yes, please list:
Does the camper have any behavioral or emotional issues?	Yes No If yes, please list:
Is the camper on any medication to treat these conditions (behavioral or emotional)?	Yes No If yes, please list:
T-Shirt Size:	Youth: XSM SM MED LG Adult: SM MED LG XL XXL
OPTIONAL: What ethnicity do you consider yourself?:	Chicana/Latina White/European American Middle Eastern/Arab American Black or African-American Asian or Pacific Islander Native American Other