Student Contact information Registration Form
Kubota Music Studio
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Email *
Student Name (First and Last name) *
Student's Date of Birth (Month/date/year) *
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DD
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Mother's Full Name *
Father's Full Name *
Guardian’s Full Name
Home Address *
Home Phone number *
Mobile Phone number *
Email *
Does the student have experience of piano lessons before? *
How did you learn about Kubota Music Studio *
Required
Today's Date *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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