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Applicant Information:

First Name*:
Last Name*:
State*: Zip*:
Home Phone*:
Work Phone:
Cell Phone:

Emergency Contact Name:*:
Phone*: eMail:*:

How did you hear of Teach the Teacher?*:
What are you hoping to gain from this course?*:
I would like to also attend the Litchfield Jazz Camp, and receive a $100 discount for camp: Week 3 Week 4
Register separately for camp here.

School Name*:
State: Zip:

Your Primary Instrument*:
Years Played*:
Jazz Skill Level*:

Number of years teaching*:
Does your school have a Jazz Ensemble/Band?*: Yes No
If so, what is the approximate size?:
Are you a college/Graduate Student?*:
If so, what level/year are you?:

Kent School Boarding
($75/per night)

You may reside on the night between course days at Kent School (space available) for a fee of $75/night per person double occupancy, which includes breakfast, lunch, and dinner.

Review all of the information above to ensure it is correct; once submitted it cannot be changed.
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Your information is kept confidential and used only for the purposes of
receiving information on the Litchfield Jazz Camp and Litchfield Jazz Festival.

Litchfield Performing Arts | P.O. Box 69, Litchfield, CT 06759 | Phone 860-361-6285 | Fax (860) 361-6288 | Contact Us