Jazz Workshop Sign-Up

Learn to play Jazz!

Complete and submit the form below and you will be contacted about the next Jazz Workshop.

NOTE: Please avoid using email addresses that may be thought to be a source of spam (hotmail.com or some other free email system).

    Today's Date (Required)

    Your Name (Required)

    Your Email (Required)

    Date of Birth (Required if student is a minor)

    Emergency Contact/Parent's name

    Emergency Contact/Parent's Email

    Emergency Contact/Parent's Phone

    Emergency Contact/Parent's Email 2

    Address (Required)

    Address Line 2

    City (Required)

    State (Required)

    Zip (Required)

    Home Phone

    Mobile Phone (Required)

    Preferred method of contact: email; phone or text? (Required)

    (If phone, please specify: home or mobile)

    Please list any food allergies or medical conditions: (Required)

    What instrument do you play? (Required)

    Drummers: Right-handed or Left-handed? (Required)

    How long have you been playing? (Required)

    Do you read music? (Required)

    If applicable, what school do you attend? What grade are you in?

    Are you currently studying privately? (Required)

    If "Yes" to the above question, who is your private teacher?

    Please indicate your level of theory/harmony? (Required)

    What is your level of understanding of chord structure and chord scales? (Required)

    Have you played in a group before? Are you currently in a group? (Required)

    Do you play any other instruments? (Required)

    Please list your availability — days & times: (Required)

    Please use the area below for any questions. Thank you!