2024-25 Amped Confirmation Registration

Youth Information

Name

Pronouns

Birthdate

Mailing Address

Youth Phone (optional)

Youth Email (optional if added, youth will receive email communications)

* If you chose other, please list below:

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

Medical Concerns/Allergies

Yes No

Please explain medical concerns or allergies:

Does the youth have any emotional or learning considerations?

Please explain emotional or learning considerations:

Parent/Guardian Information

First Adult Name

Address (if different from above)

Cell Phone

Home Phone

Email (Amped communications will be sent to this address)

Second Adult Name

Address (if different from above)

Cell Phone

Home Phone (if different from above)

Email (Amped communicatons will be sent to this address)

Volunteer Options Small Group Sub Special Events Administrative Help Projection/Slides During AMPED

Middle School Music

Middle School Music is open to all students in 6th-8th grade. Music meets before AMPED on Wednesdays at 5:00. There is time for a brief group meal together before AMPED begins.

Middle School music is led by Matt Skibo mskibo@gslcwi.com

Are you interested in Middle School Music? Yes! I'd like to participate. Possibly, I would like more information.

Payment Information

*Involvement in this program does not depend on financial ability. Scholarships are available as needed.

If you have multiple students registering, please complete a registration form for each student. You can pay all registration fees on just one student's form. From the menu below select the number of youth registrations being paid for.

Registration fee

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2024-25 Amped Confirmation Registration

Description

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