Name *

Home address *

Date of birth *

Phone number *

School *

Band director *

Grade *

Primary instrument *

Secondary instrument(s)

Shirt size *

Which ensemble(s) do you want to play in? *

How many years have you been playing your instrument(s)? *

Do you take private music lessons? *

Private music instructor *

Do you play in your high school jazz band? *

Which ensemble(s) do you perform with at your school? (select all that apply) *

Do you improvise? *

List some of your favorite jazz musicians *

How did you hear about this program? *