2020-2021 AMPED/Confirmation

Youth Information

Name

Birthdate

Address

Phone

This address will receive a confirmation email

Youth Email (optional)

*These addresses will receive Amped communications

Grade Level

6 7 8

Is the youth a Good Shepherd Member?

Yes No

Has the youth been baptized?

Yes No

Has the youth had their First Communion?

Yes No

Amped Schedule

6th graders will gather Tuesdays via Zoom from 6:15-7:15, 7th graders will gather Wednesdays via Zoom from 6:00-7:00, and 8th graders will gather Wednesdays via Zoom from 7:30-8:30. If you are unable to commit to this schedule please check this box for the home learning option of parent + youth instruction with guided videos. Yes

Parent Information

First Parent Name

Address (if different from above)

Work Phone

Cell Phone

Email (if communications are requested to be directed to this address also)

Are you willing to help on occasion (i.e. sub, special event helper, rover)? Yes

Second Parent Name

Address (if different from above)

Work Phone

Cell Phone

Email ( (if communications are requested to be directed to this address also)

Emergency Contact Name

Emergency Contact Phone Number

Medical Concerns/Allergies

Information Explanation

Middle School Music Information

Middle School Music is open to all middle school youth in grades 6-8 who are interested in learning and playing music for the worship setting. While Good Shepherd operates in Phase One, Diane Kohrs will be leading the youth via Zoom. She will incorporate piece selection, music theory, lyric analysis, and part planning for pieces. Once Good Shepherd moves to Phase Two the group will meet once a week on Wednesdays at the Verona Campus @ 5:00 pm. Note: If the number of participants warrants two offerings, arrangements will made.

Please check all that apply I am interested in participating. I would like more information on this program.

Payment Information

If you are registering 2 youth, please choose the second option - 1st & 2nd Youth, $150. We recognize at this time families may be experiencing increased financial strain. Please know there are funds available to cover these expenses if needed.

Registration Fees

Other Information

Both parent and youth will also be asked to sign a participation covenant.

In lieu of Family Night, we will provide a video explaining the program and its compnents. Families will be asked to watch the video together before the first Amped gathering, which will take place Tuesday, September 22 from 6:15-7:15 for 6th graders, Wednesday September 23 from 6:00-7:00 for 7th graders and 7:30-8:30 for 8th graders. Home school partciipants should plan to start their at-home learning that same week

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2020-2021 AMPED/Confirmation

Description

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