One moment please...
Amped Up: Planning A Youth Music Festival (cc)

Amped Up: Planning A Youth Music Festival
August 31, 2021 - October 16, 2021

7:00p-8:30p Tuesdays (in person) AND Thursdays (virtual via zoom)

Festival Day- October 16, 2021

Plugged In is an inclusive music program that empowers young musicians to make positive change in the world with their music.  Plugged In is open to any student regardless of their skill level, race, gender, sexuality, disability, religion, economic status, etc.  

Completing our online registration form will take about 5 minutes. Please be aware, there is no option to save an incomplete registration form and return to it at a later time. 

Questions marked with a red asterisk are required and must be answered before submitting your registration.

*

How did you hear about Plugged In?
Student Information
*

First Name
Last Name

*
*
*

Please indicate your preferred pronouns.
*

mm/dd/yyyy
*

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

*


*

*

Enter grade number only
Parent Contact Information
*

First Name
Last Name
*

*



First Name
Last Name

If different than parent 1


Emergency Contact Information
Whom should we contact in case of an emergency? If registering for the youth program, please provide an alternate contact to the student's parents.
*

First Name
Last Name
*

Provide the most reliable number for this emergency contact
Additional Information
*
No experience is necessary for participation in this program.
*
Check all that apply
*

What additional relevant skill(s) does the student have?
*

PLEASE CHECK ALL THAT APPLY - (Information regarding a student may be shared with the Plugged In Directors and their teachers, and will otherwise remain confidential.) .
*

Please identify and describe the student's condition.

Ex: student excels in structured environment, student requires breaks, student is shy, etc.
Plugged In is a fully inclusive program. The Plugged In Inclusion Committee acts as a resource for students/families that may need additional supports to ensure their best possible experience.
Amped Up: Class Schedule

Days and Times

Tuesdays 7:00p-8:30p (in person at Plugged In - 40 Freeman Place. Needham, MA 02492)

Thursdays 7:00p-8:30p (virtually via zoom - zoom link will be provided)

Festival Information

Final show (name to be determined by students)

October 16, 2021

Spontaenous Celebrations

45 Danforth St. Jamaica Plain, MA 02130

Policy

To participate in Plugged In you must read, understand, and agree to the following policies.  If you have questions regarding any of the following policies please contact Plugged In directly.

Read Release of Liability / Indemnity / Emergency Treatment Agreement

Read Media Release Agreement

Read Code of Conduct Agreement

Read New Student Meeting Policy (new students only)

*
*
*
*
Reminder: Parent or guardian must attend the new student meeting.
*