AMPED Create & Perform Registration Form

AMPED Create &Perform Registration Form

July 25th- 29th 2022
Practice & Play- July 25th - 29th

Where: AMPED @ Flaget (4425 Greenwood Ave)

Ages: 10-18

Time: 11am-4pm (MONDAY-FRIDAY)
Camp Description:
‘Create and Perform’ will be a more concentrated camping experience. Each child will be expected to contribute to a musical work, with the intent of sharing or performing that work at the end of the camp.
Student Name *

First Name Last Name
Student Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Birth Date *
mm/dd/yyyy format
Age *
Parent Name *

First Name Last Name
Parent Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent Email *
example@example.com
Parent Phone Number *

Area Code Phone Number
Emergency Contacts *
Where did you hear about this event?

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Does your student have any food allergies and/or medical history? *
Does your student have any experience playing an instrument? If so, what kind? *
Any questions or comments?
In consideration of the advantages of AMPED Music Academy Summer Camp, I agree to release, indemnify, and hold harmless AMPED, its agents, and employees from liability for bodily injury or property damage that might occur during this camp. If my child has a medical condition that requires health services and/or medication(s) while attending this summer camp, I have communicated those needs to AMPED staff. I agree to allow my student to attend field trips chaperoned by AMPED staff during summer camp. By signing electronically below, I confirm that I have read the information above and give my permission for my student to attend AMPED's Music Academy Summer Camp on June 13-24,2022 or July 11-22, 2022.
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AMPED Create &Perform Registration Form