Welcome to the world of Jazz! We're excited you're interested in joining our jazz music program. Please complete this form to register for classes.
Date
First Name
Middle Name/Initial
Last Name
Preferred Name (if applicable)
Date of Birth
Gender
Street Address
City
State/Province
Zip/Postal Code
Phone Number
Email Address
First Name
Last Name
Relationship to Student
Phone Number
Email Address
Instrument(s) Played: [List Instruments, e.g., Piano, Saxophone, Trumpet, Drums, Bass, Guitar, Voice, etc.]
Years of Experience on Primary Instrument:
Previous Musical Training (Formal/Informal): [Describe briefly, e.g., Private lessons, School band, Self-taught, etc.]
Experience with Jazz Music: [Describe briefly, e.g., None, Some listening experience, Played in a jazz ensemble, etc.]
Reading Music (Proficiency Level):
Beginner
Intermediate
Advanced
Playing by Ear (Proficiency Level):
Beginner
Intermediate
Advanced
Desired Class:
Class Name | Day and Time | Select | Tuition Fee per semester | Amount ($) | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Beginning Jazz Improvisation | Mondays 7:00 PM - 8:30 PM | $200.00 | $0.00 | ||
2 | Jazz Harmony and Theory | Wednesdays 6:00 PM - 7:30 PM | $200.00 | $0.00 | ||
3 | Jazz Ensemble | Thursdays 8:00 PM - 9:30 PM | $200.00 | $0.00 | ||
4 | Vocal Jazz Workshop | Saturdays 10:00 AM - 11:30 AM | $200.00 | $0.00 | ||
5 | SubTotal | $0.00 | ||||
6 | Material | $50.00 | ||||
7 | Total | $50.00 |
Total Tuition Fee:
Payment Method
Online Payment
Check
Cash
Additional information, special needs, or requests.
I understand that participation in music classes involves certain risks. I hereby release [Your Institution Name] and its instructors from any liability for injury or loss that may occur during classes or related activities.
I grant permission for [Your Institution Name] to use photographs or videos of me/my child for promotional purposes.
Signature of Student (or Parent/Guardian if student is under 18)
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