Amped Conference

Warning!

This form cannot be submitted until an administrator completes the setup process to receive online payments.

General Parent Information

Name

Spouse's Name (if applicable)

Best Contact Email

This address will receive a confirmation email

Best Contact Phone

Address

Attending Children's Information

Kids who can attend Amped are those who are going into kindergarten through those who will be going into 6th grade. Please list your children's name and birth date below.

Child's Name

Birth Date

Child's Name

Birth Date

Child's Name

Birth Date

Child's Name

Birth Date

Child's Name

Birth Date

Preschool Age Childcare

For parents who have non-school age children, childcare is available on Thursday August 16 & Friday August 17. This is for parents to participate fully in the conference. On Saturday, childcare will not be necessary. Please list all preschool children & birth dates below.

Child's Name

Birth Date

Child's Name

Birth Date

Child's Name

Birth Date

Child's Name

Birth Date

Child's Name

Birth Date

Payment

The cost of the conference is $15 for your entire family.

Payment $15.00

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.

Amped Conference

Description

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