Music Lesson Enrollment Form

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Music Lesson Enrollment Form
Student Version

* Required fields
Name *
E-mail Address *
Date *
Student Name *
Age *
Birthdate *
Grade *
Date School Begins
School *
	I wish to enroll my child in Piano
	I wish to enroll my child in Keyboards
	I wish to enroll my child in Violin
	I wish to enroll my child in Accordion
	I wish to enroll my child in Voice
Level *
Years of Study
Home Address *
City *
State *
Zip *
Parent(s) Name(s): *
Primary Phone *
Secondary Phone
Dad's Workplace
Dad's Work Telephone
Mom's Workplace
Mom's Work Telephone
	I am interested in being included on a list of students willing to trade lesson times should a scheduling conflict arise
SPECIAL INFORMATION (Please include ANY information that might be helpful. Scheduling needs, hobbies, interests. If your child has previously studied with another instructor list most recent materials and level.)

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