Kanack School of Musical Artistry - Preschool Program
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e-mail (please separate multiple e-mails with a comma): *
Student's First Name *
Student's Last Name *
Date of Birth *
Age *
Parents/Guardians Name and Occupation *
Street Address *
City *
Zip Code *
Primary Phone # *
Primary Phone Type *
Alternate Phone #
Alternate Phone Type
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Does your child have any allergies or medical conditions we should be aware of? *
Which option are you registering for? *
Information for the KSMA Office
Payment options.  Select how you would like to pay and you will be sent an invoice.  You will be able to pay that invoice online, mail a check, or by credit card over the phone.  Details about how to pay will be included in an e-mailed invoice. *
KSMA does e-mail billing only.  Paper bills will be mailed upon request.
Do you plan to apply for financial aid? *
Would you like to be part of our parent committee or any other committees at KSMA? *
PHOTO/VIDEO RELEASE: I authorize photographs/ videos of the student identified above to be used solely for teaching and/or advertising/social media for The Kanack School of Musical Artistry. *
How did you hear about us?
I certify that the information above is accurate to the best of my knowledge *
I agree to pay the TOTAL DUE for the lessons registered above according to the payment policies of KSMA. *
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