2021-2022 Amplify Teen Weekend Dates & Times

Camp will be held every third Friday night from September – April (excluding December).

Drop Off: Between 6:00 – 6:30 PM on Saturday

Pick Up: Between 1:30 – 2:00 PM on Sunday

Amplify Weekend Application (6th - 12th Grade)

Please complete the form below to register for Amplify Weekend.

Step 1 of 2

Step 1: Parent/Guardian Information
Name*
First Last
Address*
Street Address City State ZIP Code
Primary Phone*
Email*
Enter Email Confirm Email
Step 2: Student Information
Number of Students to Register*
Student name*
First Last
Gender*
Grade Level (2021-2022 School Year)*
T-Shirt Size*
Please explain any sleep or sleep walking issues?*
If there are no known sleep or sleep walking issues, enter "N/A".
Please explain any behavior or discipline issues?*
If there are no known behavior or discipline issues, enter "N/A".
Here is a list of medicines that we administer to campers on an as-needed basis. Please select the medications that you CONSENT for your child to receive as-needed while at camp.*
Please explain any medication or allergies?*
If there are no medications or known allergies, enter "N/A".
Image Release*
IMAGE RELEASE: I understand there will be photographs and video taken during the week. I hereby grant Camp Rock permission to use my child(ren)'s image in promotional material.
Student 2: Name*
First Last
Student 2: Gender*
Student 2: Grade Level (2021-2022 School Year)*
Student 2: T-Shirt Size*
Student 2: Please explain any sleep or sleep walking issues?*
If there are no known sleep or sleep walking issues, enter "N/A".
Student 2: Please explain any behavior or discipline issues?*
If there are no known behavior or discipline issues, enter "N/A".
Student 2: Here is a list of medicines that we administer to campers on an as-needed basis. Please select the medications that you CONSENT for your child to receive as-needed while at camp.*
Student 2: Please explain any medication or allergies?*
N/A
If there are no medications or known allergies, enter "N/A".
Student 2: Image Release*
IMAGE RELEASE: I understand there will be photographs and video taken during the week. I hereby grant Camp Rock permission to use my child(ren)'s image in promotional material.
Student 3: Name
First Last
Student 3: Gender*
Student 3: Grade Level (2020-2021 School Year)*
Student 3: T-Shirt Size*
Student 3: Please explain any sleep or sleep walking issues?*
N/A
If there are no known sleep or sleep walking issues, enter "N/A".
Student 3: Please explain any behavior or discipline issues?*
N/A
If there are no known behavior or discipline issues, enter "N/A".
Student 3: Here is a list of medicines that we administer to campers on an as-needed basis. Please select the medications that you CONSENT for your child to receive as-needed while at camp.*
Student 3: Please explain any medication or allergies?*
N/A
If there are no medications orknown allergies, enter "N/A".
Student 3 Image Release*
IMAGE RELEASE: I understand there will be photographs and video taken during the week. I hereby grant Camp Rock permission to use my child(ren)'s image in promotional material.
Student 4: Name*
First Last
Student 4: Gender*
Student 4: Grade Level (2020-2021 School Year)*
Student 4: T-Shirt Size*
Student 4: Please explain any sleep or sleep walking issues?*
N/A
If there are no known sleep or sleep walking issues, enter "N/A".
Student 4: Please explain any behavior or discipline issues?*
N/A
If there are no known behavior or discipline issues, enter "N/A".
Student 4: Here is a list of medicines that we administer to campers on an as-needed basis. Please select the medications that you CONSENT for your child to receive as-needed while at camp.*
Student 4: Please explain any medication or allergies?*
N/A
If there are no medications or known allergies, enter "N/A".
Student 4: Image Release*
IMAGE RELEASE: I understand there will be photographs and video taken during the week. I hereby grant Lamplight Artists permission to use my child(ren)'s image in promotional material.
Student 5: Name*
First Last
Student 5: Gender*
Student 5: Grade Level (2020-2021 School Year)*
Student 5: T-Shirt Size*
Student 5: Please explain any sleep or sleep walking issues?*
N/A
If there are no known sleep or sleep walking issues, enter "N/A".
Student 5: Please explain any behavior or discipline issues?*
N/A
If there are no known behavior or discipline issues, enter "N/A".
Student 5: Here is a list of medicines that we administer to campers on an as-needed basis. Please select the medications that you CONSENT for your child to receive as-needed while at camp.*
Student 5: Please explain any medication or allergies?*
N/A
Student 5: Image Release*
IMAGE RELEASE: I understand there will be photographs and video taken during the week. I hereby grant Camp Rock permission to use my child(ren)'s image in promotional material.
Help us can SPAM

For all groups and individuals attending an event at Adventure Weekend, we would like you to know that the Camp Rock staff considers the safety of our guests our highest priority, and follows all county and state procedures in order to ensure the utmost safety of all participants. When participating in athletic, adventure, and water activities, there is always the small possibility of accidental injury. With this in mind, please read and sign our Participant Waiver Form below:
I, on behalf of my child(en), give consent for my child to participate in programming at Camp Rock of Georgia. This waiver is signed as an acknowledgement that Camp Rock staff is not liable in the unlikely event of an accidental injury. I hereby release and hold harmless Camp Rock of Georgia, their volunteers, and employees from liability for bodily personal injury, arising as a result of medical and/or dental treatment given to participants and guests prior to their participation in Camp Rock of GA activities. I give consent for the staff and volunteers of Camp Rock of Georgia to act on my child’s behalf should I be unable to do so. I give consent to the camp to provide or assist in the provision of reasonable medical/dental care and treatment deemed necessary for my child’s well-being for the duration of their stay at camp. Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), Camp Rock of Georgia is taking extra precautions with the care of every camper and volunteer to include health history review and enhanced sanitation/disinfecting procedures in compliance with CDC guidance. Before arriving at camp, I will ensure that my camper has not had or been in contact with an individual who has had a fever, dry cough, difficulty breathing, or fatigue and consent to a health history review upon arrival at Camp Rock of Georgia events. I acknowledge that Camp Rock of Georgia reserves the right to dismiss (without refund) any persons(s) who does not abide by its policies. If a dispute over this agreement or any claim for damages arises, I agree to resolve the matter through a mutually acceptable arbitration process.
Digital Signature*
Submission of this form indicates agreement to the waiver terms listed therein. Please enter your first and last name to serve as your digital signature.
First Last
Phone
This field is for validation purposes and should be left unchanged.

2021-2022 Amplify Teen Weekend Dates & Times

Amplify Weekend Application (6th - 12th Grade)

Step 1 of 2

Step 1: Parent/Guardian Information

Step 2: Student Information