Test

JAM Registration Form

Student Name(Required)

DOB(Required)

Date of Birth

Name of School(Required)

Grade(Required)

Homeschooled?(Required)

Yes

1st Choice Instrument(Required)

Do you have your own? 1st Instrument(Required)

Yes

2nd Choice Instrument

Do you have your own? 2nd Instrument

Yes

Prior Instrument(s), if any(Required)

Parent/Guardian Name(s)(Required)

Parent Guardian Phone(s)(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

1st Emergency Contact(Required)

Relationship(Required)

1st Emergency Phone(Required)

2nd Emergency Contact

Relationship

2nd Emergency Phone

3rd Emergency Contact

Relationship

3rd Emergency Phone

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

Yes

Who may pick up your child from JAM?(Required)

Jam Registration (Required)

Price: $1.00

Jam Registration

Total

Credit Card

79704

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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