Clone of Teen 2026 Summer Camp Music Academy Registration Form

1
How did you hear about us?
Social Media
Community Event/Organization
Flyer/Print Advertisement
Word of Mouth
Referral from Friend
Referral from Current Student
Website
2
Program ID
3
Student ID
4
Account ID
5
Parent/Guardian E-mail* This field is required.
example@example.com
6
Student Name* This field is required.
First Name
Last Name
7
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
8
Application Name
9
Has your child been a part of Amped's Music Academy in the past?* This field is required.
YESNO
10
Student Date of Birth* This field is required.Your student must be between the ages of 13 years old by June 1, 2026 to be eligible for this camp.
Date
Month
Day
Year
11
Which ethnicity best describes the student?* This field is required.
Hispanic or Latino
Not Hispanic or Latino
12
Which race best describes the student?
Alaskan Native/American Indian/Indigenous American/Native American
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Some Other Race
13
Student Gender Identity* This field is required.
Male
Female
Nonbinary
14
Which type of student are you registering?* This field is required.
Elementary School Student
Middle School Student
High School Student
15
Student Current Grade Level in August* This field is required.
Please Select
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
16
Is your student enrolled in Jefferson County Public Schools (Louisville, Kentucky)?* This field is required.
Yes
No
17
Please select your students schooling environment.
Please Select
Please Select
Homeschool
Private School
Public School Outside of Jefferson County
18
Which JCPS Elementary school will your student attend in August?
Please Select
Please Select
Atkinson Elementary School
Auburndale Elementary School
Audubon Traditional Elementary School
Bates Elementary School
Blake Elementary School
Bloom Elementary School
Blue Lick Elementary School
Bowen Elementary School
Albert S. Brandeis Elementary School
Breckinridge-Franklin Elementary School
Byck Elementary School
Camp Taylor Elementary School
Cane Run Elementary School
Carter Traditional School
Chancey Elementary School
Chenoweth Elementary School
Cochran Elementary School
Cochrane Elementary School
Coleridge-Taylor Montessori Elementary School
Coral Ridge Elementary School
Crums Lane Elementary School
Dixie Elementary School
Dunn Elementary School
Eisenhower Elementary School
Engelhard Elementary School
Fairdale Elementary School
Farmer Elementary School
Fern Creek Elementary School
Field Elementary School
Foster Academy
Frayser Elementary School
Gilmore Lane Elementary School
Goldsmith Elementary School
Greathouse/Shryock Traditional Elementary School
Greenwood Elementary School
Gutermuth Elementary School
Hartstern Elementary School
Hawthorne Elementary School
Hazelwood Elementary School
Hite Elementary School
Indian Trail Elementary School
Jacob Elementary School
Jeffersontown Elementary School
Johnsontown Road Elementary School
Kennedy Montessori School
Kenwood Elementary School
Kerrick Elementary School
King Elementary School
Klondike Lane Elementary School
Laukhuf Elementary School
Layne Elementary School
Lincoln Elementary Performing Arts School
Lowe Elementary School
Luhr Elementary School
Maupin Elementary School
McFerran Preparatory Academy
Medora Elementary School
Middletown Elementary School
Mill Creek Elementary School
Minors Lane Elementary School
Norton Elementary School
Okolona Elementary School
Portland Elementary School
Price Elementary School
Rangeland Elementary School
Roosevelt-Perry Elementary School
Rutherford Elementary School
St. Matthews Elementary School
Sanders Elementary School
Schaffner Traditional School
Semple Elementary School
Shacklette Elementary School
Shelby Traditional Academy
Slaughter Elementary School
Smyrna Elementary School
Stonestreet Elementary School
Stopher Elementary School
Trunnell Elementary School
Tully Elementary School
Watson Lane Elementary School
Watterson Elementary School
Wellington Elementary School
Wheatley Elementary School
Wheeler Elementary School
Wilder Elementary School
Wilkerson Elementary School
Wilt Elementary School
Young Elementary School
Zachary Taylor Elementary School
19
Which JCPS Middle School will your student attend in August?
Please Select
Please Select
Academy @ Shawnee
Barret Traditional Middle School
Carrithers Middle School
Conway Middle School
Crosby Middle School
Echo Trail Middle School
Farnsley Middle School
Grace M. James Academy of Excellence
Highland Middle School
Hudson Middle School
J. Graham Brown School (K–12)
Jefferson County Traditional Middle School
Johnson Traditional Middle School
Kammerer Middle School
Knight Middle School
Lassiter Middle School
Marion C. Moore School (High and Middle)
Meyzeek Middle School
Newburg Middle School
Noe Middle School
Olmstead Academy North
Ramsey Middle School
Thomas Jefferson Middle School
Westport Middle School
Western Middle School for the Arts
W.E.B. DuBois Academy
20
Which JCPS High School will your student attend in August?
Please Select
Please Select
Atherton High School
Ballard High School
Brown (J. Graham) School
Butler Traditional High School
Central High Magnet Career Academy
Doss High School
duPont Manual High School
Eastern High School
Fairdale High School
Fern Creek High School
Grace M. James Academy of Excellence
Iroquois High School
Jeffersontown High School
Louisville Male High School
Marion C. Moore School
Pleasure Ridge Park High School
Seneca High School
Southern High School
The Academy @ Shawnee
Valley High School
Waggener High School
W.E.B. DuBois Academy
Western High School
Youth Performing Arts School (YPAS) at Manual
21
Does student have any known allergies? If yes, please list known allergies
22
Does student have any pre-existing medical conditions that we should be made aware of?
23
Class DescriptionsPlease review class descriptions before making selections.
24
Provide your first choice class* This field is required.
Audio Engineering
Creative Writing
Drums
Guitar
Music Production
Music Production Online Only (Must have a computer and internet connection)
Piano
Vocals
25
Provide your second choice class
Audio Engineering
Creative Writing
Drums
Guitar
Music Production
Music Production Online Only (Must have a computer and internet connection)
Piano
Vocals
26
Provide your third choice class
Audio Engineering
Creative Writing
Drums
Guitar
Music Production
Music Production Online Only (Must have a computer and internet connection)
Piano
Vocals
27
Monday Availability* This field is required.Select all the times your student is available on this day of the week. If none, select 'Unavailable.'
3:30 PM
4:00 PM
4:30 PM
5:00 PM
5:30 PM
6:00 PM
6:30 PM
7:00 PM
7:30 PM
Unavailable
28
Tuesday Availability* This field is required.Select all the times your student is available on this day of the week. If none, select 'Unavailable.'
3:30 PM
4:00 PM
4:30 PM
5:00 PM
5:30 PM
6:00 PM
6:30 PM
7:00 PM
7:30 PM
Unavailable
29
Wednesday Availability* This field is required.Select all the times your student is available on this day of the week. If none, select 'Unavailable.'
3:30 PM
4:00 PM
4:30 PM
5:00 PM
5:30 PM
6:00 PM
6:30 PM
7:00 PM
7:30 PM
Unavailable
30
Thursday Availability* This field is required.Select all the times your student is available on this day of the week. If none, select 'Unavailable.'
3:30 PM
4:00 PM
4:30 PM
5:00 PM
5:30 PM
6:00 PM
6:30 PM
7:00 PM
7:30 PM
Unavailable
31
Anything else we should know about your student’s schedule, transportation, or class preferences?Please note: AMPED does not provide transportation. Each family is responsible for ensuring their student is transported to and from all lessons, classes, and program activities.
Huge
Large
Normal
Small
Ok
Ok
32
Number of people living in household (all children and adults)* This field is required.
33
Total Household Income* This field is required.
$0-$20,300
$20,301-$32,150
$32,151-$43,150
$43,151-$54,150
$54,151-$69,600
$69,601-$83,500
$83,501-$102,050
$102,051 or more
34
Parent/Guardian Name* This field is required.
First Name
Last Name
35
Parent/Guardian Relationship to student* This field is required.
Please Select
Please Select
Parent
Guardian
Grandparent
Aunt
Uncle
Sibling
Family Friend
Other Relative
Other
36
Parent/Guardian Phone Number* This field is required.
Please enter a valid phone number.
37
Would you like to include information for a secondary parent/guardian?* This field is required.
Yes
No
38
Secondary Parent/Guardian E-mail
example@example.com
39
Secondary Parent/Guardian Relationship to student
Please Select
Please Select
Parent
Guardian
Grandparent
Aunt
Uncle
Sibling
Family Friend
Other Relative
Other
40
Secondary Parent/Guardian
First Name
Last Name
41
Secondary Parent/Guardian Phone Number
Please enter a valid phone number.
42
Please list names and phone numbers of individuals authorized to pick up your child.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
43
Are we allowed to administer over the counter medicine to student(s)?* This field is required.
Yes
No
44
Do we have permission to view education records for your student(s)?* This field is required.
Yes
No
45
Do we have permission to take photos and videos of you and your student(s)?* This field is required.
Yes
No
Should be Empty: