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AGES 12-18. Payment will be remitted the first day of lessons, February 12th. Please fill in all fields.  Type N/A if it doesn't apply.
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Student Name *
Student Cell Number (if applicable) *
Student Email Address *
Parent Name *
Parent Cell Number *
Parent Email Address *
Mailing Address *
Please describe any medical conditions of which we need to be aware. *
Any additional comments? *
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