AMPLIFY 2022 Registration

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**PLEASE READ BEFORE BEGINNING**
1. REGISTRATION MUST BE COMPLETED BY THE CAMPER'S PARENT OR GUARDIAN.
2. Please register each camper individually and have insurance cards available.
3. This is a detailed application with medical information required, so please allow adequate time to complete.
4. Last Step is Payment which will be done through Paypal. You can pay the full registration, just the parent portion if your church is paying a part, or choose mail a check. Punch cards for snacks are also available.

电子邮件地址 *

Which camp? *

High School Week (July 8-12)

Middle School Week (July 12-16)

First Name *

Please list first name of camper

Last Name *

Please list last name of camper

Address *

City *

State *

Enter 2 digit State code (all caps)

Zip *

Student Cell Phone *

(with dashes, ex. 123-456-7890) (If none, please fill in "none".)

Gender *

Male

Female

Date of Birth *

年

月

日

Grade in the Fall *

School Name *

T-Shirt Size *

(Adult sizes.)

2XL

3XL

Roommate Requests

(You may list individuals or church or youth groups. No guarantees. Counselor requests are not considered.)

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