Student Name *

First Name

Last Name

Student Phone *

Can be parent's cell phone if desired.

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School's Band or Jazz Director Name *

First Name

Last Name

School's Band or Jazz Director Phone *

(###)

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Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone *

(###)

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Checkbox Attest *

By checking the box below you attest the following statement is true.

By submitting and continuing with this application I attest that I have my parent/guardian's permission to participate in the Junior High Jazz Workshop