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Register Today!

THE JAZZ EXCHANGE SUMMER WORKSHOP

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The Jazz Exchange 2023 Summer Workshop

Primary Parent First Name

Primary Parent Last Name

Primary Parent Email

Primary Phone Number

Secondary Parent First Name

Secondary Parent Last Name

Secondary Parent Email

Seconday Parent Phone Number

You are this person's parent or legal guardian You must be the parent or legal guardian to register someone under 18 years old.

Students First Name

Students Last Name

Students Birthday (Ages 12-18)

Country

Address

Address Line 2

City

State

ZIP

Student Gender Identity

Male

Female

Neutral

Prefer not to say

Student Pronouns

She/her/hers

He/him/his

They/them/theirs

Prefer not to say

Ethnicity

This information is used for grant applications for Jazz Exchange. We appreciate you taking the time to answer.

Student Email Address

Home Phone Number

Student Cell Phone Number

School Attending as of 2023-2024

Primary Instrument

Emergency Contact 1 Name

Emergency Contact 1 Phone Number

Emergency Contact 1 Relationship to Student

Emergency Contact 2 Name + Relationship

Emergency Contact 2 Phone Number

Emergency Contact 2 Relationship to Student

Please list anyone not authorized to pick up your child

Please list any allergies (food, medicine, enviornmental) and whether your child carries an EpiPen

Does your child take any medication that will need (or may need) to be administered during Jazz Exchange Summer Camp hours or events?

Does your child carry any medications ie inhaler...

If applicable, please state the amount/dose is given and how it is given.

Has your child had a recent infectious disease?

Does your child have Type 1 or Type 2 Diabetes?

Has your child ever been treated for and/or diagnosed with attention deficit disorder (ADD) or attention deficit/hyperactivity disorder (AD/HD)?

Has your child ever been treated for and/or diagnosed with emotional or behavioral difficulties or an eating disorder?

During the past 12 months, has your child seen a professional to address mental/emotional health concerns?

Has there been a significant life event that continues to affect your child's life? (For example has there been a history of abuse, death of a loved one, family change, adoption, foster care)

The Jazz Exhange has my permission to video and photograph my child while participating in the 2023 Jazz Exchange Sumer Workshop and all activities associated with it for archival, commercial, publicity/marketing, and/or production uses.

I Agree

I do not agree

Please read the following waivers and agreements carefully. They include release of liability and waiver of legal rights, and deprive you of the ability to sue certain parties. By checking the box you are agreeing electronically, you acknowledge that you have both read and understood all text presented to you as part of the registration process. Click to reviewWAIVERS + AGREEMENTS

Digital Signature - By signing my name below, I acknowledge that I have read and agree to all the waivers and agreements that I have selected above.

Thanks for Registering!

EXECUTIVE PRODUCER

SPECIAL THANKS

Candice Reyes
President & Founder
Vocalist

Abel Mireles
Artistic Director / Founder
Saxophonist

About us.

Building Communities Through Music

The Jazz Exchange is a minority-led organization that curates creative programming, offering audiences

to discover new venues, meet new people, experience new artists, and mentor future generations of young artists.

Candice Reyes and Abel Mireles are leading The Jazz Exchange with a strong passion for music, education, and community building. Their professional musicianship has enabled them to create a program that helps support underserved artists and local businesses with mentorship and music education.

The Jazz Exchange has earned a reputation both nationally and globally for their commitment to fostering personal growth, creating new opportunities, and preparing future citizens. By working together with artists, businesses, and freelancers, The Jazz Exchange offers unique and welcoming spaces that allow people to discover new places, meet new faces, and experience new artists.

Meet Our Team

Candice Reyes-Mireles

President & Founder

Sandra Martinez

Board Member

Abel Mireles

Artistic Director & Founder

Carlos Nino

Board Member

YOUR SUPPORT CAN HELP US

TO BE THE INSTRUMENT OF CHANGE

GIVE TODAY!