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Register for
Alleghany JAM only
Mon & Wed
Appalachian Arts only
Tuesday Only
Alleghany JAM & Appalachian Arts
Mon, Tues & Wed
How many children in your family are you registering today
One
Two
Three
Student One
Student One Last Name
Student One Age
Student One Birthdate
Student One Grade
Student One School
Student 1: Have you been in JAM before?
Yes
No
Student #1: Do you have your own instrument to play?
(optional)
Yes
No
Student #1: What instrument do you have?
(optional)
Student #1: First Instrument Choice
Select only one
Fiddle
Banjo
Guitar
Mandolin
Student #1: Second Instrument Choice
Select only one
Fiddle
Banjo
Guitar
Mandolin
Student #1: Activity Choice #1
Select ONE
Singing
Dance
Dulcimer
Ukulele
String Band
Returning Students only
Student #1: Activity Choice #2
Select ONE
Singing
Dance
Dulcimer
Ukulele
String Band
Returning Students only
Student Two
Student Two Last Name
Student Two Age
Student Two Birthday
Student Two Grade
Student Two School
Student 2: Have you been in JAM Before?
Yes
No
Student 2: Do you have your own instrument to play
Yes
No
Student 2: What instrument do you have?
Student 2: First instrument Choice
Select only one
Fiddle
Banjo
Guitar
Mandolin
Student 2: Second instrument Choice
Select only one
Fiddle
Banjo
Guitar
Mandolin
Student 2: First Activity Choice
Singing
Dance
Dulcimer
Ukulele
String Band
Returning Students ONLY
Student 2: Second Activity Choice
Singing
Dance
Dulcimer
Ukulele
String Band
Returning Students ONLY
Student Three
Student Three Last Name
(optional)
Student Three Age
Student Three Birthday
Student Three Grade
Student Three School
Student 3: Have you been in JAM before?
Yes
No
Student 3: Do you have your own instrument to play?
(optional)
Yes
No
Student 3: What instrument do you have?
guitar, banjo, fiddle, mandolin?
Student 3: First instrument Choice
Fiddle
Banjo
Guitar
Mandolin
Student 3: Second instrument Choice
Fiddle
Banjo
Guitar
Mandolin
Student 3: First Activity Choice
Singing
Dance
Dulcimer
Ukulele
String Band
Returning Students ONLY
Student 3: Second Activity Choice
Singing
Dance
Dulcimer
Ukulele
String Band
Returning Students ONLY
Parent Info
Address
City
State
Zip Code
Parent/Guardian Emergancy Contact #1
#1 Relationship
Phone #1
#1 Phone is:
Cell
Home
Work
Email #1
Parent/Guardian Emergancy Contact #2
#2 Relationship
#2 Phone Number
#2 Phone is:
Cell
Home
Work
Email #2
Does your child/children have any physical/health issues we should know about?
I give Alleghany JAM permission to use photos/videos of my child to promote the JAM program in social or print media. We will not list your child's name for safety reasons
What fee do you qualify for:
Normal Fee
Reduced Fee
Payment
$
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