JAMcamp Registration Form
415.425.0372 * charity@jamjamjam.com * www.jamjamjam.com

If you have not previously registered your child for a JAMcamp or JAMclass, please fill out the form below. Thank you. We look forward to JAMming with you!

Camp Information

Please choose your JAMcamp date(s): *

WINTER JAMcamp: Monday Feb 17 -- FULL (please add me to the waitlist)

Student Information

Child #1:

First Name *

Last Name *

Birth Date *

Age *

Grade (current school year): *

Name of school, if applicable:

Child #2:

First Name

Last Name

Birth Date

Age

Grade (current school year):

Name of school, if applicable:

Parent/Guardian/Emergency Contact Information

Parent/Guardian #1:

First Name *

Last Name *

Relationship to child(ren) *

Main Phone (xxx-xxx-xxxx) *

Alternate Phone (xxx-xxx-xxxx) *

Email Address *

Address *

City *

State *

Zip *

Parent/Guardian #2:

First Name *

Last Name *

Relationship to child(ren) *

Main Phone (xxx-xxx-xxxx) *

Alternate Phone (xxx-xxx-xxxx) *

Email Address

Address (if different from above) 🛈

City

State

Zip

Please provide one ADDITIONAL emergency contact:

First Name *

Last Name *

Relationship to child(ren) *

Main Phone (xxx-xxx-xxxx) *

Alternate Phone (xxx-xxx-xxxx)

Lastly...

Any allergies, medications, or physical or mental health issues we should be aware of?

How did you hear about us? *

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