JAM Student Registration Fall 2019
Please fill out the form below to register your student for the Galax JAM program in Fall 2019.
Email address *
Student Name *
Your answer
Student Status *
First Choice Instrument *
Second Choice Instrument *
School Attending 2019-2020 *
Your answer
Parent/Guardian Name *
Your answer
Primary Phone *
Your answer
This phone is my: *
Other Phone
Your answer
Address Line 1 *
Your answer
Address Line 2 *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Secondary Contact in Case of an Emergency *
Your answer
In Case of Emergency Contact phone *
Your answer
Tuition Rate *
Number of students in Family *
Your answer
Total Tuition Due $ *
Your answer
JAM Fees
There are several payment options available: one full payment, two half payments, weekly or bi-weekly payments (please note that you still pay the full tuition amount regardless of whether your child misses a class), or other, as arranged with the Director. Checks can be made payable to: Chestnut Creek School of the Arts or JAM or you can pay in full online after you have been accepted into the program. www.chestnutcreekarts.org/jam
Please check your payment choice below *
Parent/Guardian Signature
My child has permission to participate in JAM and I agree that CCSA and JAM may use any audio, video or photographs taken of my child while participating in JAM classes or events (names will not be used). My child will attend JAM classes and exhibit good attitude and behaviors while in attendance and will practice regularly.
Please type your name to "sign" *
Your answer
For More Information
Contact Kevin Powell, JAM Program Director, call (276) 236-3500 or email jam@chestnutcreekarts.org
A copy of your responses will be emailed to the address you provided.
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