NCMACC Registration Form

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* Indicates required question

Name of Student *

Your answer

Birthdate *

MM

/

DD

/

YYYY

Address *

Your answer

City *

Your answer

Zip *

Your answer

Parent/Guardian *

Your answer

Phone *

Your answer

Email *

Your answer

School Currently Attending *

Your answer

Choice of Instrument *

Piano

Voice

Violin

Guitar

Required

Three Preferred Lesson Schedule( e.g Monday, anytime from 3 PM to 6 PM; Thursday 2 PM etc..) *

Your answer

Photo Release *

Yes, my child's photo may be used

No, my child's photo may not be used

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This form was created inside of Northern California Music & Art Culture Center.

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