JAMMS Registration

JAMMS

Registration
Participant Information
Name *

First Name Last Name
Age *
Location & dates of program you are registering for *
Religion *
Culture / ethnicity *
What country were you born in? *
Gender *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone *

Area Code Phone Number
Cell Phone *

Area Code Phone Number
E-mail *
Parent / Guardian Information
Name *

Prefix First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone *

Area Code Phone Number
Cell Phone *

Area Code Phone Number
E-mail *
Participant Questionnaire
What styles of music do you like? *
What styles of films do you like? *
What musical instrument do you play, if any, and how long have you been playing? *
Do you sing / rap? *

Yes No
Do you write songs, lyrics, or poems? *

Yes No
Have you ever used a video camera? *

Yes No
I am interested in (check all that apply): *

Writing songs Performing Audio engineering Videography / filming Photography Graphic Design / artwork
Why do you want to participate in the JAMMS program? *
What do you hope to gain from this experience? *
What do you think you can contribute to the program? *
Can music & film create social change? Why or why not? *
Cultural, religious, and ethnic observances
The JAMMS program is a multi-cultural, multi-faith program comprised of participants from diverse and varied backgrounds. We recognize this as a personal preference and while we will make every effort to accommodate all observances, it is important for all participants and their families to understand that it is equally important for us to not mandate any individual's participation in a religious or cultural observance. The commitment and welfare of the entire group is our priority.
Please list and describe any and all religious observances or cultural traditions that take place during the program. *
Health and Medical Information
Please list any dietary restrictions for health or religious reasons *
Please list all known allergies including food allergies *
Please describe anything we need to know about your medical background including any known medical conditions and medications you are taking *
Are there any emotional or mental health needs or concerns that we need to be aware of? *

Yes No
If yes, please describe
Media Consent
I understand that my child will be filmed, photographed, and recorded in the JAMMS program. Music in Common shares these recordings and videos with a worldwide audience via the Internet and with other MiC programs in an effort to interconnect students across the globe. By signing this letter, you are consenting to the recording, filming, and photographing by Music in Common, Inc. of your child’s participation in the JAMMS program and hereby granting Music in Common, Inc. the right to include their name and likeness in future promotional and commercially released materials including, but not limited to, CDs, DVDs, digital downloads, and audio and video clip postings on the internet. Music in Common, Inc. owns the rights to these audio and video recordings and photographs and may use them for the purpose of promoting and fundraising for Music in Common, Inc. and MiC youth programs.
Parent / guardian signature (type name here) *
Participant Agreement
I understand that the JAMMS program is open to a limited number of participants and that my enrollment in the program may take away someone else's opportunity to particpate. As such, I agree to attend each and every program session, to be fully engaged and participatory in the program, and acknowledge that misconduct of any form may be grounds for dismissal.
Participant signature (type name here) *
Should be Empty:

JAMMS

Participant Information

Parent / Guardian Information

Participant Questionnaire

Cultural, religious, and ethnic observances

Health and Medical Information

Media Consent

Participant Agreement