New Jersey Jazz Academy Registration Fall 2021 Student's Name* First Last Parent or Guardian's Name* First Last Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Cell Phone Number*Email Address* Student's Grade*Select Grade7 (minimum grade requirement)89101112Instrument*Select InstrumentAlto SaxophoneTenor SaxophoneBaritone SaxophoneTrumpetTrombonePianoGuitarVocalsFlute/PiccoloClarinetVibes/XylophoneDrum SetUpright or Electric BassNumber of years playing experience*Select Number of Years23455+How did you hear about the New Jersey Jazz Academy? Mailing List Sign up for Elefante Music's mailing list to find out about new and upcoming classes! No thanks. May Elefante Music use photographic images and sound bytes of your child for promotional material? Yes No Class DetailsNew Jersey Jazz Academy Fall 2021*Thursdays October 7 – December 2 (8 classes) 7:00pm – 8:30pm Price: COVID Procedures for In-Person Classes Agreement*In keeping with the recommendations regarding the prevention of the spread of COVID-19, all students and teachers must wear masks for group classes. For woodwind and brass instruments, bell covers must be used. Students and teachers may pull down their face masks to play woodwind and brass instruments, but masks should immediately be pulled back over noses and mouths when not playing. I have read and agree to Elefante's COVID requirements.Payment InformationCredit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Security Code Cardholder Name TotalReview your total. By clicking SUBMIT, you authorize your card to be charged for this amount.