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Registration Form
Student Name*
Date of Birth (if under 18 - N/A if Over 18)*
Student Phone Number*
Student Email*
I would like to receive SMS text message reminders before each lesson
I would like to receive email reminders before each lesson
Medical conditions or special considerations we need to be aware of?
Instructor Name
Musical Discipline (Instrument)
Start Date (if known)
Preferred Lesson Type*
In-Person
Virtual (Zoom)
Virtual (Skype)
Virtual (Other Platform)
Primary Contact Name*
Primary Contact Number*
Primary Contact Email*
Primary Contact Mailing Address*
Secondary Contact Name (if applicable)
Secondary Contact Number
Secondary Contact Email
Emergency Contact Name & Number*
Signature (Parent Signature if under 18)*
Date*
I have read & understand the General Payment & Cancellation Policy listed below*
Repeat Email Address