Amped Rego 2025

First Childs Name *

First Name

Last Name

Second Childs Name

First Name

Last Name

Third Childs Name

First Name

Last Name

Parent / Caregivers Name *

First Name

Last Name

Phone *

(###)

###

####

Emergency contact *

First Name

Last Name

Phone *

(###)

###

####

I give my permission for my child/ren to take part in activities within our local community, accompanied by leaders. Any activities further afield will be notified as/when they will occur in regular newsletters or by email. I accept the information on this form will be kept on record by the MBC ministries for administrative purposes.

Yes

I am aware that photos and videos will be taken that may feature my child/ren and could be used in our closed facebook page weekly update. If there is a legal reason why this is not possible let us know.

Yes

Scholarships – We want to partner with families to remove as many barriers as possible for kids attending Amped. Scholarships that cover term fees are available to families in need. However, there may still be additional costs for activities at venues that charge, like Extreme Edge Rock Climbing and uniform. If you would like to provide a scholarship for another family, please tick the box below. We will add an extra $35 to your term fees or $140 to your annual fees.

Yes would like to sponsor a scholarship