JAMMS Registration

JAMMS

Registration
Participant Information

Thank you for your interest in JAMMS. Please fill out the information below. You will need to complete the payment information on the PayPal page in order for the form to submit. If you are need of tuition assistance, please check the Tuition Assistance box at the bottom of this form.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Location & dates of program you are registering for*
How did you hear about the program*
As part of our ongoing effort to empower youth against hate, Music In Common strives to cultivate rich and diverse programs. Thank you for sharing a little bit about yourself.
Religion*
Culture / ethnicity*
What country were you born in?*
Gender*
Preferred Pronoun
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone*

Area CodePhone Number
E-mail*
Parent / Guardian Information
Name*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone*

Area CodePhone 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?*

YesNo
Do you write songs, lyrics, or poems?*

YesNo
Have you ever used a video camera?*

YesNo
I am interested in (check all that apply):*

Writing songsPerformingAudio engineeringVideography / filmingPhotographyGraphic 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 choice 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?*

YesNo
If yes, please describe
Media Consent
I understand that I / 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 / 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 programs.
Participant Signature (type name here)*
Parent / guardian signature if participant under 18 (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)*
Tuition*
prevnext( X )
Summer JAMMS August 3-7$275.00

Summer JAMMS Tuition Assistance$ Free

Total $0.00
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JAMMS

Participant Information

Parent / Guardian Information

Participant Questionnaire

Cultural, religious, and ethnic observances

Health and Medical Information

Media Consent

Participant Agreement