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Private Lesson Form 17-18
Please sign up by Friday August 19. See Mr. Giel with any questions.
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Student Name (Last, First)
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Student Instrument
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Violin
Viola
Cello
Bass
School
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Lakeside High School
Henderson Middle School
Parent/ Guardian Last Name
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Parent/ Guardian First Name
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Your answer
Parent/ Guardian Email Address
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Parent/ Guardian Phone Number (Home or Cell)
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Is the student currently taking private lessons?
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Yes
No
If student is taking lessons, please list the private teacher name.
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