Music Works Academy Beatrice - Summer Yoga Series Survey
We are located at 2920 E Court - Beatrice - Please use this questionnaire to help us with Summer Class planning.
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Email *
1. Student Name (if multiple students, please add below) *
Are you an Adult Student?
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2. Parent Name: (if student is a child)
Are you already enrolled in our MyMusicStaff Academy Student Portal? *
3.Student Names #1
4. Student Name #2 
5. Student Name #3
Student #1 Birthdate: *
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YYYY
6. Student #2 Birthdate:
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DD
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YYYY
7. Student #3 Birthdate:
MM
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DD
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YYYY
Email: *
Confirm Email: *
Address: *
Phone: *
What kind of Yoga class or lesson are you interested in for Summer? *
What type and length of lesson do you prefer? *
What is the best day for your lesson time? *
What is the best time for your lesson? *
Are you interested in any of the following Yoga Classes? *
Do any students listed here have special needs or require special accommodations? Please list below:
How did you hear about us?
Did a current student refer you? Let us know so we can credit their account:
Other Information: Please include any other information that we need to know about your Summer lesson requests or scheduling.
Tell us about any concerns or questions you have about participating in a Yoga or Meditation Class: 
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