Music Academy
Last Name:
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First Name:
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Name of Student's School:
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Student's Grade in School:
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Student's Date of Birth:
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Enter Valid Date
Semester:
Summer
Please Select
Years Previous Lessions:
Preferred Teacher:
If you are a new student how did you hear about the Music Academy:
Periodically we update pictures on the web site, using photos of our students at recitals, outreach program, the Barnes & Noble Bookfair, or posed shots.
If you will allow the Music Academy to use photos of your student, please complete the following information.
Allow Photos
Do not allow photos
Parent/Guardian Last Name:
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Parent/Guardian First Name:
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Home Phone:
Cell/Work Phone:
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Email Address:
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Street Address:
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City:
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State:
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Zip Code:
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