Registration Form | Young Lions Jazz Conservatory

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Student First Name *

Student Last Name *

Primary Instrument *

School You Attend

Graduation Year *

Please enter the year you anticipate you will graduate from high school.

Gender

Please Enter M, F, or Other

Student Email *

Student Phone

Student Address *

Street Name and Number (and Unit)

City *

State *

Zip *

Parent 1 First Name *

Parent 1 Last Name *

Parent 1 Email *

Parent 1 Phone

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Phone

Comment

Young Lions Jazz Conservatory is a 501(C) (3) Nonprofit EIN: 82-1899094