Spring Registration 2024-2025

"*" indicates required fields

Parent/Guardian Information

Parent Name*

First Last

Email address*

Phone number*

We will never sell or share your phone number or personal information!

May we text you?*

Yes

We will text you to remind you of dates and deadlines; emergency information regarding inclement weather, and personally regarding your child(ren).

Address*

City*

State*

ZIP*

Choose Reduced Payment Option

Alleghany Jam Classes Only	$130 for the First Child	Siblings are 20% off
Appalachian Arts Class Only	$70 for the First Child
Alleghany Jam & Appalachian Arts	$200 for the First Child
Reduced Payment Option
Alleghany Jam Classes Only	$70 for the First Child
Appalachian Arts Class Only	$30 for the First Child
Alleghany Jam & Appalachian Arts	$100 for the First Child

How many children do you want to register?*

Child One Information

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Child's Name*

First Last

Child's Age*

Child's Birthdate*

Child's School*

Child's Grade*

Child's First Instrument Choice (returning students get priority)*

Child's Second Instrument Choice (in case they don't get first choice)*

Child's First Activity Choice*

Child's Second Activity Choice*

Has Child been in JAM Before*

Any physical/health issues we should be aware of?*

Child Two Information

This field is hidden when viewing the form

Child's Name*

First Last

Child's Age*

Child's Birthdate*

Child's School*

Child's Grade*

Child's First Instrument Choice (returning students get priority)*

Child's Second Instrument Choice (in case they don't get first choice)*

Child's First Activity Choice*

Child's Second Activity Choice*

Has Child been in JAM Before*

Any physical/health issues we should be aware of?*

Child Three Information

This field is hidden when viewing the form

Child's Name*

First Last

Child's Age*

Child's Birthdate*

Child's School*

Child's Grade*

Child's First Instrument Choice (returning students get priority)*

Child's Second Instrument Choice (in case they don't get first choice)*

Child's First Activity Choice*

Child's Second Activity Choice*

Has Child been in JAM Before*

Any physical/health issues we should be aware of?*

Child Four Information

This field is hidden when viewing the form

Child's Name*

First Last

Child's Age*

Child's Birthdate*

Child's School*

Child's Grade*

Child's First Instrument Choice (returning students get priority)*

Child's Second Instrument Choice (in case they don't get first choice)*

Child's First Activity Choice*

Child's Second Activity Choice*

Has Child been in JAM Before*

Any physical/health issues we should be aware of?*

Child Five Information

This field is hidden when viewing the form

Child's Name*

First Last

Child's Age*

Child's Birthdate*

Child's School*

Child's Grade*

Child's First Instrument Choice (returning students get priority)*

Child's Second Instrument Choice (in case they don't get first choice)*

Child's First Activity Choice*

Child's Second Activity Choice*

Has Child been in JAM Before*

Any physical/health issues we should be aware of?*

In Case of Emergency

Emergency Contact Name*

First Last

Emergency Contact Relationship*

Emergency Phone Number*

My child may be picked up by/travel with:*

First Last

Other than known parents/guardians

Contact Phone Number*

My child may be picked up by/travel with:

First Last

Other than known parents/guardians

Contact Phone Number

My child may NOT be picked up by:

First Last

Comments (Optional and Confidential):

I give Alleghany JAM permission to use photos/videos of my child in AJAM in social or print media. (We will not list your child's name for safety reasons.)*

Alleghany Class Registration Total

Price:

Total

How would you like to pay?*

Check/Cash

Credit Card

PayPal

Credit Card*

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Payment Method*

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

This field is for validation purposes and should be left unchanged.

Spring Registration 2024-2025

Parent/Guardian Information

Child One Information

Child Two Information

Child Three Information

Child Four Information

Child Five Information

In Case of Emergency

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Alleghany JAM

Spring Registration 2024-2025

Parent/Guardian Information

Child One Information

Child Two Information

Child Three Information

Child Four Information

Child Five Information

In Case of Emergency

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