Register - Alleghany Junior Appalachian Musicians

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Please complete the form below to register online. If you prefer a printable form click here.

September 10, 2019

Students registering September 10th or later will be added to a waiting list and will be contacted in order of registration if/when we have openings.

Student First Name

Student Last Name

Are you a returning or first-time JAM student?

First Time Returning

Student Age

Student birthday

Student Grade

Student School

Any health issues we should know about?

Yes No

If yes please describe:

Address

City

State

Zip

Parent/Guardian 1

Email 1

Phone Best to Reach Guardian 1

Parent/Guardian 2

Email 2

Phone Best to Reach Guardian #2

Emergency Contact

Emergency Phone #

Relationship

Do you have your own instrument to play?

Yes No

What instrument do you have?

First Instrument Choice

Fiddle

Banjo

Guitar

Mandolin

Second Instrument Choice

Fiddle

Banjo

Guitar

Mandolin

First Activity Choice

Singing

Dance

Dulcimer

Mandolin

Second Activity Choice

Singing

Dance

Dulcimer

Mandolin

What fee do you qualify for?

Normal Reduced

Photo

Yes No I give AJAM permission to use photos/videos of my child to promote the AJAM program in social or print media. (We will not list your child's name for safety reasons)

Parent's initials

Have any questions?

336-572-5266

Need some help?

alleghanyjaminfo@gmail.com

Our Board

Our Board of Directors