Inclusion Jam Session
General Interest Form
Student Full Name
*
First Name
Last Name
Birthday
*
-
Month
-
Day
Year
Date
Caregiver Name (if applicable)
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Instrument
*
Proficiency Level
*
Please Select
Beginner
Beginner/Intermediate
Intermediate
Intermediate/Advanced
Advanced
Have you had private lessons before?
*
Please Select
Yes
No
If yes, how long?
Would you be interested in playing a secondary instrument?
*
Please Select
Yes
No
If yes, what instrument?
Have you ever played in a band before?
*
Please Select
Yes
No
If yes, how long?
Availability
*
Thursday's 7:00 PM
Fridays 5:00 PM
Other
Collaboration
*
I understand the drop is sessions are for various age groups and varied musical experiences.
Collaboration
*
I understand myself/my student will be accompanied by a caregiver if myself/my student needs assistance to access the drop in jam sessions.
Any song or artist requests?
Submit
Should be Empty: