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The Goddard School of Cordova Private Lesson Registration
The Goddard School of Cordova
Contact:
(901)864-8000
striveschoolofmusic@gmail.com
Email address *
Student Name *
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Address *
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City,State *
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Zipcode *
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Age *
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Gender *
Birthdate *
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School
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Lesson/class *
Parent/Guardian Name *
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Has your child registered for the summer camp or been affiliated with Strive School of Music? *
If you answered "yes" for the previous question , please Fill out the additional student information below.
Relationship to Student *
Work Number
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Cell Number
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E-mail
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Parent/ Guardian Name
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Relationship to Student
E-mail
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Work Number
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Cell Number
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Emergency Contact Name
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Relationship to Student
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Work Number
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Cell Number
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Hospital *
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Physician
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Office Number
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Does the Participant
If you checked a Box for items 1-6 ,please specify below . ( Include number)
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I acknowledge and agree to pay ALL Strive School of Music fees *
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