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Student Name*
First Last
Age*
Grade (if applicable)
Instrument*
School (if applicable)
Primary Parent/Guardian Name (if applicable)
First Last
Primary Email*
Primary Phone*
Secondary Parent/Guardian Name (if applicable)
First Last
Secondary Email
Secondary Phone
Courses
Ensembles Interested in:
- Jazz
- Rock, R&B and Funk
Classes:
- Music Theory
- Composition/Arranging
Open Jazz Intensive Series:
- Next date TBD
Additional Comments/Request
Photo and Video Release*
- By checking this box, The Westchester Center for Jazz and Contemporary Music has my permission to use my or my child’s photograph publicly to promote the Center. I understand that the images may be used in print publications, online publications, websites, and social media.

Courses