Dickenson & WiseJAMs Student Application

The JAMS after-school music program is a financially accessible opportunity for youth to learn traditional mountain music. JAMs offers lessons on banjo, fiddle, and guitar. Cultural Enrichment programming in Appalachian history and culture are also a part of the program. The conclusion of each semester, will offer opportunities for students to perform.

During open enrollment, students in 4th-12th grade can choose their preferred instrument. We will provide a loaner instrument for students who do not have one!

Classes run for two hours, one afternoon each week, for 13 weeks in a given semester. Programs are currently offered at the Southwest Virginia Museum in Big Stone Gap, at L.F. Addington Middle School, and Ridgeview middle/high school. Cost per student is $10 for each 2hr. class or $100 for the full 13 classes.

Student Information

Student's First Name *

Student's Last Name *

Age *

Grade *

School *

Instrument Interest *

Dietary/Allergy restrictions *

Needs/Disabilities

Gender

Socio Economic Need

Race/Ethnicity

Parent/Guardian Information

Guardian's Name (First and Last) *

Guardian's Email *

Guardian's Phone # *

Emergency Contact Information

Name- Emergency Contact 1 *

Phone- Emergency Contact 1 *

Relationship- Emergency Contact 1 *

Name- Emergency Contact 2

Phone- Emergency Contact 2

Relationship- Emergency Contact 2

Media Consent *

By typing your name in this field, you consent to allowing the JAMs program to electronically record (audio, video, photographs) portions of your child's participation in JAMs programming for educational, archival and promotional purposes, only for those purposes. (consent is not require

Signature *

By checking this box, you affirm that you are a legal parent or guardian to the student named herein, that you consent to that students participation in JAMs programming, and that the information you have provided is accurate at the time of completion to the best of your knowledge.