AMPLIFY 2021 Registration
**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 the application.
4. Once submitted, please complete Step 2, payment to finalize registration. Don't miss the early bird rate which ends April 30th!
5. IMPORTANT NOTE FOR MEDICATIONS!! Any prescription medication brought to camp MUST be accompanied by a signed Medication Administration Authorization form from the camper's practitioner (form can be obtained from our website).
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Email *
Which camp will you be attending? *
(Students enter 9th grade may attend both)
Camper First Name *
Camper Last Name *
Address *
City *
State *
Enter 2 digit State code (all caps)
Zip *
Student Cell Phone *
(If none, please fill in "none".)
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Grade in the Fall 2021 *
School Name *
T-Shirt Size *
(Adult sizes.)
Roommate Requests
(You may list individuals or church or youth groups. No guarantees. Counselor requests are not considered.)
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