🎵 AMLA Youth Anti-Violence Songwriting Program

Registration Form "Your Voice. Your Song. Your Impact."

AMLA's Youth Anti-Violence Songwriting Program is a free, five-week summer experience for youth ages 15-20 to explore songwriting, beat-making, and social justice through music. You'll work with professional artists and a music therapist to create and record original songs with messages of peace and empowerment. The program concludes with a community performance. Participants who complete the program will receive a $250 stipend. Dates: Late June 30 - August 1, 2025 (5 weeks)

there is a performance on Friday August 1, 2025 from 6 - 8 PM

Schedule: Monday-Thursday, 10:00 AM - 2:00 PM

Location: AMLA, 4261 N. 5th Street, Philadelphia, PA 19140

Final Showcase: Community concert featuring student work
Full Name
Preferred Name/Nickname (if any): Date of Birth (MM/DD/YYYY):
Preferred NameNickname if any
Date of Birth MMDDYYYY

MonthDayYear
Date
Age on June 1, 2025: Phone Number
Age on June 1 2025
Email Address
example@example.com
Home Address
CityNeighborhood
Current School Name
Grade Level (as of Spring 2025): 9th10th11th

Do you participate in any school music or arts programs? YesNo
MUSICAL BACKGROUND
What are your main musical interests? (Check all that apply) SingingRappingPoetry/Spoken Word Songwriting Playing an InstrumentBeat-MakingRecording/Mixing

Which instrument(s) do you play (if any)? Skill Level:Intermediate Beginner
Which instruments do you play if any
Have you ever recorded music before?YesNo Do you use music software/apps? If yes, which ones?
Do you use music software apps
SHORT ANSWERS
Why are you interested in this program What do you hope to learn or express through your music?
What does antiviolence mean to you How does it relate to your community or personal experience?
PARENT/GUARDIAN INFORMATION (If under 18)
ParentGuardian Full Name
Phone Number
EMERGENCY CONTACT
Full Name
Phone Number
Relationship to Student
Please check to confirm your consent

I give permission for AMLA to photograph and/or video record me during the program for promotional purposes.
I understand that I must attend all sessions to receive the $250 stipend.
SIGNATURES
Student Signature

Clear
Date

MonthDayYear
Date
ParentGuardian Signature if under 18

Clear
Date

MonthDayYear
Date
SUBMITTING YOUR FORM
Please submit this form by June 1, 2025: Email: amla@esperanza.us

Drop-off: AMLA, 4261 N. 5th Street, Philadelphia, PA 19140

Questions? Call us at (215) 324-0746 or visit www.amla.org
Should be Empty:

MUSICAL BACKGROUND

SHORT ANSWERS

EMERGENCY CONTACT

SIGNATURES

SUBMITTING YOUR FORM