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Youth First Name
*
Youth Last Name
*
Gender
Male
Female
Age
*
Grade next fall:
Current School
Birthday
*
Parent/Guardian Name
*
Street Address
*
City
*
Postal Code
*
Phone Number
*
Email Address
*
Pick Up Authorization
🛈
How did you hear about or youth camp opportunities?
*
Been to a previous camp
Referred to by a friend
Saw promotional material
Other:
Other:
What is your adult T-Shirt size?
*
Participation
I am part of Amplify at Southside
I have not been part of Amplify at Southside