JBY Academy & Performing Arts Conservatory™
nonprofit arts education & academic enrichment school
Pre-Registration Form
JBY's Mentoring Program for Preteen & Teen Girls
Child's Name
First Name
Last Name
Parent's/Guardian's Email (for those under the age of 18/minors)
example@example.com
Child's Age
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Child's Current Grade
Parent's/Guardian's First and Last Name
Parent's/Guardian's Home Phone number
Will your child attend in person or virtually? (program will have in person meetups weekly after school; in Easton and/or Bethlehem, PA (Virtual participation can be offered for those who cannot attend in person)
Please Select
In person
Virtually
Session registering for...
Please Select
This Summer 2024 (June-August)
New School Year 2024-2025
Parent/Guardian Cell number
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How did you hear about this JBY program?
Please Select
Email invitation
Social Media (Facebook)
Social Media (TikTok)
Social Media (Instagram)
YouTube Ad
Google/Web Search
Word of Mouth/Referral
Has your child ever participated in a previous JBY workshop or program?
Please Select
Yes
No
Interested in JBY Volunteering?
Please Select
Yes
No
Mom's are encouraged to occasionally volunteer. If you would like to volunteer we will send you a separate volunteer registration. We appreciate you.
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Can you please briefly share what you hope your child will gain by participating in the program? Thank you! We will be in touch soon.
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