Colorado Jazz Ambassadors

Primary Parent/Guardian Information

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Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian PronounsHe / HimShe / HerThey / Them

Parent's Email *

Confirm Email Address *

Parent's Mobile Phone

Parent's Street Address *

Parent's Apartment, suite, etc

Parent's City *

Parent's State/Province *

Parent's ZIP / Postal Code *

Does Student live full-time at this address?Yes or NoYesNo

Student Information

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Student's First Name *

Student's Last Name *

Student's PronounsHe / HimShe / HerThey / Them

Student's Email (if applicable)

Student's Mobile Phone (if applicable)

Student's Primary InstrumentSelect Primary InstrumentAlto SaxophoneTenor SaxophoneBari SaxophoneTenor TromboneBass TromboneTrumpetPianoGuitarBassDrums / PercussionFluteClarinetVocalOther

Student's Secondary Instrument (if applicable)Select Secondary InstrumentAlto SaxophoneTenor SaxophoneBari SaxophoneTenor TromboneBass TromboneTrumpetPianoGuitarBassDrums / PercussionOther

Student's Grade Level (upcoming school year)Select Grade Level5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade

Student's Birth Date

MonthSelect month123456789101112

DaySelect day12345678910111213141516171819202122232425262728293031

YearSelect Year212521242123212221212120211921182117211621152114211321122111211021092108210721062105210421032102210121002099209820972096209520942093209220912090208920882087208620852084208320822081208020792078207720762075207420732072207120702069206820672066206520642063206220612060205920582057205620552054205320522051205020492048204720462045204420432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925

Student's School

Student's Special Needs and Dietary Restrictions

Secondary Parent/Guardian Information

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Secondary Parent/Guardian First Name

Secondary Parent/Guardian Last Name

Secondary Parent/Guardian PronounsHe / HimShe / HerThey / Them

Secondary Parent's Email

Secondary Parent's Mobile Phone

Does secondary parent live at the street address listed above?Yes or NoYesNo

Secondary Parent's Street Address

Secondary Parent's Apartment, suite, etc

Secondary Parent's City

Secondary Parent's State/Province

Secondary Parent's ZIP / Postal Code

How often does Student live at this address?Select an OptionFull-TimePart-TimeLess than Part-Time

Registration Information and Costs

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In which band would student prefer to participate?Choose BandSchool Year Intermediate BandSchool Year Advanced Band (audition may be required)Summer Camp

Would you like to pay the full summer camp tuition up-front, or in monthly installments?A $25 discount will be applied for full up-front payment.Select an OptionUp-Front – $395Monthly – $420 total

Select Number of Monthly Payments – Summer CampSelect an OptionTwo Months @ $210 per monthThree Months @ 140 per month

Will student participate in out-of-state travel to festivals and/or competitions?Yes or NoYesNo

Would you prefer to pay for your student's travel up-front or over monthly installments?Travel is estimated at $1,200. A CJA representative will contact you to set up payment arrangements for summer travel.Select an OptionUp FrontMonthly Installments

CJA Summer Program – Full Up-Front Payment

USD

CJA Summer Program – Monthly Installments (four months)

USD

CJA Summer Program – Monthly Installments (three months)

USD

CJA Summer Program – Monthly Installments (two months)

USD

Total Due Today

$

CJA Tuition Payment *

Register for CJASave as Draft