Kids Jam Registration

Please submit one form per child.

1. Student Name: *
First Name
Middle
Last Name
Birthday:*
Grade in September: *
School:*
Parent Name: *
First Name
Middle
Last Name
Parent Name:
First Name
Middle
Last Name
Address: *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Allergies/Concerns:
Home Phone:*
Cell Phone:*
If address is different than students' residence please provide contact information below.
Parent's Address:
Emergency Phone:
Parent's Email Address:*
I am willing to volunteer with the musical.
ONLY AUTHORIZED INDIVIDUALS BELOW WILL BE ALLOWED TO DROPOFF/PICKUP ANY CHILD. ANY EMERGENCY CHANGES PLEASE CALL 610.399.3377.
Contact One Name:*
Contact One Phone: *
Contact Two Name
Contact Two Phone
Contact Three Name:
Contact Three Phone:
*