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Financial Responsibility/Guardian Email
Student Full Name
*
Mailing City
*
SINGLE LESSON APPLICATION: Student Information (Page 2 of 2)
Mailing State
*
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Mailing Zip
*
Financial Responsibility/Guardian Name
Study Options
*
60 Minute Voice Lesson @ $70.00 Per Lesson
45 Minute Voice Lesson @ $60.00 Per Lesson
60 Minute Piano Lesson @ $60.00 Per Lesson
45 Minute Piano Lesson @ $45.00 Per Lesson
Student Phone
*
Student Email:
*
STUDENT INFORMATION (Is the Student a minor?)
*
Yes - Complete the Student AND Parent/Guardian Information section.
No - Complete only the Student Information Section leave the Parent/Guardian Section blank.
Mailing Address (Include Apt/Ste No., if applicable)
*
Student Date of Birth
*
Certification
I certify that all of the information above is complete and true to the best of my knowledge.
Financial Responsibility/Guardian Phone
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