Test

JAM Registration Form

Student Name

DOB

School

Grade

Homeschooled?

Yes

1st Choice Instrument

Do you have your own?

Yes

2nd Choice Instrument

Do you have your own?

Yes

Prior Instrument(s), if any

Parent/Guardian Name(s)

Phone(s)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact

Relationship

Phone

Will you be able to provide transportation for your student(s) to and from JAM?

Yes

Who may pick up your child from JAM?

Signature

Date

We have paper forms available as well.

Please make checks payable to “JCAC – JAM” in the amount of $100.00 per child and mail to or Drop off at: Jackson County Arts Council, 310 Keener Street, Room 201, Sylva, NC 28779

JAM Registration Form

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