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MoonAmie Productions Registration Form
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Email
*
Your email
Date
*
Your answer
Student's Name
*
Your answer
Age
*
Your answer
Grade
*
Your answer
Birthday
*
Your answer
Guardian's Name (If under 18 years of age)
Your answer
Relationship to Student
Your answer
Address
*
Your answer
Phone Number (Guardian)
*
Your answer
Phone Number (Student)
Your answer
Email (Guardian)
*
Your answer
Email (Student)
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Student Pick Up: List of names of those approved to pick up & drop off student
Your answer
Lessons: Please select the type of lesson(s) for which you're registering
*
Private
Semi-Private
Group
Acting with Monica
Dance
Required
How did you hear about MoonAmie Productions?
*
Your answer
By submitting this form, you agree to have read and agree to all MoonAmie Productions' policies and code of conduct.
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