Family Jam Registration Form

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Enjoy a musical afternoon with the family in this special weekly hour-and-a-half rock camp style workshop!

You will learn songs together in a group setting with experienced and supportive musicians that want you and your family to have fun and explore a variety of instruments while playing family-friendly songs together.

No musical experience necessary, all instruments provided, songs vary on a weekly basis and include one acoustic and one electric song choice each week with free time and instrumental exploration encouraged.

$10 - $15 per person sliding scale, one class per week on Sundays from 1:00 pm - 2:30 pm.

Registration required, missed workshops must be rescheduled and will not be refunded. Family and group rates available upon request.

A form must be filled out for each student or family member attending separately.

A MEPAA staff member will contact you to confirm space available in the workshop and process payment details to finalize your registration.

Family Jam is located at:

MEPAA Music & Arts Center
2370 Parliament Street

Eugene, OR 97405

Email *

Name of Contact Person or Guardian *

Name of Workshop Participant *

Participant Date of Birth *

YYYY

Date of Workshop Registering For - Sundays (excluding some holidays) *

YYYY

Best Contact Phone Number *

Mailing Address *

Any allergies or medical conditions? *

Musical Experience? (Not required, just curious!) *

Any other circumstances you would like us to be aware of? *

How did you hear about MEPAA? *

Demographics

Many of our funders want to know information about WHO we serve.

Please share as much as you are comfortable and know that this information helps MEPAA provide access to the arts for more families.

Are any of the following items true for the participant? *

LGBTQ+

Native American

Hispanic or Latine

African American

Asian American/Pacific Islander

BIPOC (Black/Indigenous Person of Color)

Multiracial/Mixed Heritage

Low Income

Single Parent Household

Learning Disability

Neurodivergent

Mental or physical impairment/challenge

Anxiety and/or Depression

Other:

Required

MEPAA Nondiscrimination Policy

MEPAA does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. We are committed to providing an inclusive and welcoming environment at our events and activities, and ask our volunteers to make the same commitment through their actions, language, and conduct when volunteering with the organization.

Photo/Video Release *

MEPAA classes and events may be filmed or have photos taken. By agreeing to this option you are authorizing us to use class photos or videos for organizational marketing purposes only. Names will not be included unless specifically requested.

I agree

I do not agree and would not like myself and/or my family to be excluded from photos or video posts.

MEPAA Music & Arts Center Liability Release and Hold Harmless Addendum (Communicable Diseases including COVID-19)

Communicable Diseases Including COVID-19: The novel coronavirus (“COVID-19”), has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. While rules, guidance, and personal discipline may reduce this risk, the risk of serious illness and death does exist. MEPAA Music & Arts Center (MAC) cannot completely mitigate the transfer of communicable diseases like COVID- 19.By selecting this box, I acknowledge that I understand there is some risk associated with using MAC facilities and assume said risk. Use of MAC facilities includes possible exposure to and illness, injury, or death from infectious diseases including COVID-19. I understand the hazards of COVID-19 and am familiar with the Centers for Disease Control Prevention (“CDC”) guidelines; and federal, state, and local orders regarding COVID-19. I acknowledge that I understand the circumstances regarding COVID-19 and will take all necessary precautions as provided by the CDC and federal, state, and local governments. Indemnification: In consideration for use of the MEPAA Music & Arts Center property, I agree to waive and discharge any and all claims against the MAC and release it from liability for any loss regardless of cause, including claims for any negligent actions of the MAC or its employees or agents and any and all claims, demands, lawsuits, judgments, losses, or expenses of any nature arising out of User’s failure to follow the CDC, federal, state, or local orders or guidance regarding COVID-19 and that leads to, directly or indirectly, the infection of COVID-19 or any other illness or injury related to COVID-19, to the fullest extent allowed by law. I also agree to release, exonerate, discharge and Hold Harmless the MAC, its Board of Directors, the individual members thereof, and all officers, agents, employees, volunteers, and representatives from all liability, claims, causes of action, or demands, including attorney fees, arising out of injuries of any kind to myself, my child, or to our property, or losses of any kind which may result from or in connection with the use of the MAC’s facility, up to and including injuries stemming from the negligent actions of the MAC or its employees or agents. I certify and represent that I have the legal authority to waive, discharge, release, and hold harmless the released parties on behalf of itself and its members, employees, agents, contractors, suppliers, or guests. *

I agree

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