Student Name *

Student Name

First Name

Last Name

Parent/Guardian Name

Parent Name only needed if student is under 18

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthdate *

Student Birth Date

MM

DD

YYYY

Instrument *

1-on-1 Voice

1-on-1 Piano

1-on-1 Organ

Group Piano

Group Voice

Preferred Lesson Day *

You can select up to 3 days. Please Note our hours are M-F 9AM-7PM, Sat. 9AM-1PM. Group lessons are offered on Tuesday and Wednesday.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

How did you hear about JAMS Academy? *

Facebook

Instagram

Google

Youtube

Referral from JAMS Student

Referral from JAMS Instructor

Mesquite ISD

Other

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