Jam Session Participant Registration Spring/Summer 2018
PLEASE NOTE! You must submit this registration online in order to complete your registration. If you are unable to, please call us at 619-299-1411 and we will register you. On site registrations will not be accepted.
Participant's Full Name *
Your answer
Preferred Location for Spring 2018 *
(Wednesday evenings 7-8pm - Point Loma) (Wednesday evenings 7-8pm-Oceanside) (Thursday evenings 7-8pm - El Cajon) (Thursday evenings 7-8pm - Chula Vista)
Required
Birthdate *
Your answer
Age (participant must be 13 years or older) *
Grade (or NA) *
Your answer
Name of school, transition or day program *
Your answer
Diagnosis and level of delay (e.g. mild, mod, severe, etc.) *
Your answer
Parents/Guardian Name *
Your answer
Phone *
Your answer
Email *
Your answer
Address *
Your answer
City *
Your answer
Zip Code *
Your answer
If your teen/young adult is a returning Jam Session participant, please let us know any details that may have changed in the last year for your student that may assist our staff and volunteers to provide an optimal experience for him or her.
(e.g. behaviors, motivators, music preferences, challenges, etc.).
Your answer
Did you register for the Jam Session program last season (Fall 2017)? *
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