Amped Rego 2025 First Child's Name * First Name Last Name Second Child's Name First Name Last Name Third Child's Name First Name Last Name Parent / Caregiver * First Name Last Name Phone * (###) ### #### Email * Emergency Contact * First Name Last Name Phone (###) ### #### Relevant Medical Details - Allergies etc * 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 - I would like a scholarship No Thank you!
