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Date of registration …………………………………………………………..
Parents’ Names/Adult Student Name
…………..............................................
Address ………………………………………………………………………
City …………………………………Zip ……………………………………
Occupation/ Company(Father)…………………………….Telephone………
Occupation/Company (Mother) ……………………………Telephone……..
Home Phone ………………………….Cell Phone…………………………..
Email Address ………………………………………………………………..
Student Name ………………………………………………………………...
Age …………………………Date of Birth ………………………………….
Grade …………………………School ………………………………………
Instrument …………………………………………………………………….
Instructor ……………………………. New Student ………………………...
Continuing Student …………………………………………………………...
Type of Lesson (30, 45, 60 min.)……………………………………………...
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