Youth Jazz Workshop

JAI - Camp Registration Form

Student Information

Student First Name(*)
Please let us know your first name.

Student Last Name(*)
Please let us know the students last name.

Rising Grade(*)
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D.O.B(*)
Please provide the student date of birth.

Home Adress(*)
Please prove us with your home address

City (*)
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State(*)
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Zip(*)
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Music History

School(*)
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Primary Instrument(*)
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Years Playing Primary Instrument (*)
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Additional Instrument (Optional)
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Years Playing Additional Instrument
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Music Education

Private Music Lessons(*)
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If "Yes", instructor's name:
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School Concert Band(*)
Select "Yes" or "No"

School Jazz Band(*)
Select "Yes" or "No"

Honor Bands (All-State, All District, Regional)(*)
Select "Yes" or "No"

If "Yes", Band Name:
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Parent Information

Parent/Guardian Name(*)
Please provide us with the Parent/Guardian Name

Email(*)
Please let us know your email address.

Cell Phone(*)
Please provide us with your cell phone number.

Work Phone(*)
Please provide us with your work phone number.

Emergency Contact(*)
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Emergency Contact Phone(*)
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How did you hear about this program?
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T-Shirt Size
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Please Note: You are registering for Summer Camp. Final Cost: $295.00