Student Contact information Registration Form
Kubota Music Studio
* Required
Email address
*
Your email
Student Name
*
Your answer
Student's Date of Birth (Month/date/year)
*
MM
/
DD
/
YYYY
Mother's Name
*
Your answer
Father's Name
*
Your answer
Home Address
*
Your answer
Home Phone number
*
Your answer
Mobile Phone number
*
Your answer
Email
*
Your answer
Does the student have experience of piano lessons before?
*
Yes (less than 1 year)
Yes (1~2 years)
Yes (more than 2 years)
No
How did you learn about Kubota Music Studio
*
Facebook
Google Search
Baltimore's Child magazine
Mount Washington Improvement Association Newsletter
RCM
MTA Website
MTAGB Website
Refer from Steinway
Refer from Friend
Sakura Japan News
Other:
Required
Today's Date
*
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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