2012 Dis This! a Disability and Media Camp

Submitted by Admin on Fri, 10/14/2011 - 13:55

Reel Grrls, the award-winning after school media and technology program for young women is seeking teen girls 13 to 18 to tell their stories and learn about film in our brand new program: Dis This! a Disability and Media Camp.

View examples of past Reel Grrls videos.

How to apply: Complete and submit the online registration form below. If under the age of 18, print and sign the Mediacal and Liability Release Form and return it to Reel Grrls: 1409 21st Ave, Seattle WA 98122

Note: your application is not complete until you have submitted both the online form and the permission form!

Dates: Spring Break: Monday April 16th - Friday April 20th, 10am - 4pm
Location: Reel Grrls New Media Lab in Seattle's Central District, 1409 21st Ave, Seattle, WA 98122
Who can apply: Disabled and non-disabled teen girls ages 13 - 18.
Cost: $275. Pay-what-you-can. No one turned away due to lack of funds.
Application Deadline: Extended to April 9th, 2012

Don't forget to print and sign the Medical and Liability Release Form and return it with payment to Reel Grrls at 1409 21st Ave, Seattle WA 98122. Your registration is not confirmed until we receive your release form and payment voucher.

Please contact Program Coordinator Monica Olsson at (206) 323-0693 or monica@reelgrrls.org with any questions.

We embrace all ways of being a grrl. Whatever kind of grrl you are, you are welcome here.

We welcome participants of any race, class, ethnicity, religion, disability, age, national origin, sexual orientation, and language.

Contact Info

Participant Name: *

Address: *

City: *

State: *

Zip: *

Phone: *

Participant Email: *

Parent/Guardian Name: *

Parent/Guardian Address, if different from above:

Parent/Guardian Phone: *

Parent/Guardian Email: *

Parent/Guardian Name 2:

Parent/Guardian Address 2, if different from above:

Parent/Guardian Phone 2:

Parent/Guardian Email 2:

Teen lives with :

Mother

Father

Guardian

Other

If 'other':

Optional Identity Questions

This information is for recording purposes only. It does not affect acceptance of your application in any way.

Other:

Program Application

Please tell us about yourself by answering one or both of the following questions. Feel free to submit your answer in the form of a poem, script, photo, collage or video - anything that tells us about you.

1. Tell us about a character in TV or film with a disability that you know of. Why do you like or dislike this character? 2. What kinds of disabled characters do you want to see or what kinds of stories about disability do you want to tell? : *

Attachment (if any):

Upload a file to accompany your application.

Computer Use

(Optional) Please select any of the following types of computers you have used in the past at home, school, or work. Select all that apply.

PCs (Personal Computer, i.e. Dell, Toshiba, Gateway)

Macintosh (Other apple products)

Desktop

Laptop

Where do you use computers? (Select all that apply):

School

Home

Work

Confidential Sliding Scale Payment Info

Reel Grrls is committed to serving grrls of all economic levels. All of our program fees are based on a pay-what-you-can system. You may also choose to pay in installments. Please make a minimum payment of $20 with your application.

How much can you contribute toward the $275? (please send with your payment voucher): * $ .00

Additional amount to contribute to the Reel Grrls Scholarship fund:: $ .00

Confidential Medical and Emergency Information

This information does not affect the acceptance of your application in any way. It purely enables Reel Grrls to create a safe and healthy environment for you as an apprentice, should your application be accepted.

Emergency Contact Name: *

Emergency Contact Relationship: *

Emergency Contact Phone: *

Medical History

Do you have any allergies or take any medication(s) that we need to be aware of?: *

Yes

Do you have any medical information we need to be aware of?:

Yes

If you answered yes to any of the above, please explain in the space below. Please share any additional important personal or medical information you feel will help us best serve you:

Describe any accommodations you may need to participate in our program:

Dietary Needs:

I am a vegetarian

I don't eat dairy products

I have other dietary needs

Any additional information (diet or medical information)?:

Friend me on:

Facebook and my username is:

MySpace and my username is:

Twitter and my username is:

Flickr and my username is:

YouTube and my username is:

Lucia

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2012 Dis This! a Disability and Media Camp