Jam Connections Registration

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Jam Connections Registration

Jam Connections - Register & Pay

Thank you for your interest in Jam Connections. Cost is $60 per person, which includes all 6 classes in the session.

Please Read Regarding Payment Options:

Self-Direction Funding:
We recommend that you send a list of requested recreation activities to your FI for confirmation of self-direction funding. You will be held responsible for all payments not funded by self-direction.

FSS Funding:
We recommend that you reach out to your local FSS provider to ensure that the list of requested recreation activities are reimbursable through FSS funding. You will be held responsible for all payments not funded by FSS.

Private Payments
Follow prompts on this page to move forward with payment options.

Please contact Kaylyne Samways, Kelberman Manager of Respite and Recreation, with any questions regarding recreation activities and/or payment options at kaylyne.samways@kelbermancenter.org or (315) 922-6502.

( * ) indicates required field

FIRST name of the person applying for Jam Connections *

LAST name of the person applying for Jam Connections *

Primary phone number to contact for applicant *

Primary email address to contact for applicant *

Applicant's birthday (Must be ages 5-18 to participate) *

Do you receive Kelberman services? *

Yes

Unsure

If yes, what services? If no services, please write N/A *

Will you be attending with a staff/caregiver? If so, please provide name *

Please include any additional information that may be helpful to Kelberman staff

$60.00

Qty

Total Amount

$0.00

Payment Information