2021 Camp Registration Form

Which program are you registering for?*

Please fill out the following electronic medical form to provide confidential medical information for each student attending a JAM program

Student Name*

First Last

Student's Email Address*

T-Shirt Size*

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Adult T-shirt Size

Instrument including Vocal and Training

Select your Instrument*

List Other Instrument and/or Multiple instruments here:

Number of Years of Formal Music Training

Previous Training in Jazz Improvisation

Yes
No

Have you been previously enrolled to the JAM Camp?*

Yes
No

If yes, what year did you enroll to the Camp?

School

School's Name*

City*

State*

Grade Entering in Fall 2026*

Student's Home Information

Street Address*

City*

State*

Zip*

Phone

Parent and/or Guardian Declaration

Parent 1 Name*

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Parent 1

Parent's Email Address (Primary)(valid email required)*

Parent 2 Name

Additional Email Addresses

Parent's Daytime Phone*

SMS Consent*

Check here to consent to receive text messages from the Jazz Academy.

I agree to receive SMS text messages from Jazz Academy of Music / JAM Camp at the phone number provided above. Messages may include camp updates, schedule reminders, and emergency notifications. Message frequency varies. Message and data rates may apply. Reply STOP to unsubscribe at any time. Reply HELP for assistance.

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Additional Phone

Emergency Contacts

Contact 1 Name*

Contact 1 Relationship*

Contact 1 Phone (Camp Hours)*

Contact 2 Name

Contact 2 Relationship

Contact 2 Phone (Camp Hours)

All information is True and Correct*

Yes

Payment Plan (Optional/Select Deposit on Tuition Page)

Available payment options

Are you interested in a private lesson?

Survey Question

How did you hear about the JAM Camps?

Note other source, including teacher here:

JAM Camp Registration Form

Instrument including Vocal and Training

School

Student's Home Information

Parent and/or Guardian Declaration

Emergency Contacts

Payment Plan (Optional/Select Deposit on Tuition Page)

Survey Question

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