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Summer 2016 Registration
Camps, Lessons, and Lesson Blocks at the Music Institute at Carrollton Square.
For adult student registrations please copy your information in the student and Parent/Guardian 1 areas.
Student Name *
Your answer
E-mail
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian 1 *
Your answer
Parent/Guardian 1 e-mail *
Your answer
Parent/Guardian 2
Your answer
Parent/Guardian 2 e-mail
Your answer
Address *
Your answer
Phone *
Your answer
Private Lesson Instrument *
Required
Preferred Teacher?
Your answer
Lesson Package *
Lesson Length *
Summer Camp Selection *
Summer Camp Length *
How did you hear about us?
Your answer
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