**Please disregard start and end dates below and enter N/A for instrument, lesson length and preferred lesson day when entering student details.**

**This class meets on Tuesdays from 1:15-2:00pm starting October 1st 2019 through the end of the school year.**

**Fee is $16 per class billed monthly for the number of classes held that month (in most cases 4 classes)

**There is a $70 registration fee. Included in the registration fee is your childs' Junior Jammer t shirt, instrument tote bag and all of the instruments your child will be using in class (xylophone, rhythm sticks, hand drum, shakers, etc).
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Home Phone: Cell #: Work #:
Email: (Emails are kept confidential)
Address: *
City: * State: * Zip: *
Students entered below will be added to your family's account
Additional Information:
Other Questions/Comments:
Credit Card Verification:
Card Number: *  
Name as it appears on card: *
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*