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Student Registration
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* Indicates required question
Email
*
Your email
Student Name:
*
Your answer
Date of Birth:
*
MM
/
DD
/
YYYY
Instrument & Years of Study
*
(violin, viola, cello, double bass, piano) e.g., violin 4, viola 1
Your answer
Orchestral Experience:
(Please include name of conductor/teacher/coach.)
Your answer
Private Teacher:
(if applicable)
Your answer
Private Teacher Email address:
(if applicable)
Your answer
Private Teacher Cell number:
(if applicable)
Your answer
Current School and Grade:
*
Your answer
Parent/Guardian (Main Contact) Name
*
Your answer
Parent/Guardian (Main Contact) Email address:
*
Your answer
Parent/Guardian (Main Contact) Cell Number:
*
Your answer
2nd Parent/Guardian Name
Your answer
2nd Parent/Guardian Email address:
Your answer
2nd Parent/Guardian Cell phone Number
Your answer
Home Address:
*
Your answer
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