MoonAmie Productions Registration Form
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Email *
Date *
Student's Name *
Age *
Grade *
Birthday *
Guardian's Name (If under 18 years of age)
Relationship to Student
Address *
Phone Number (Guardian) *
Phone Number (Student)
Email (Guardian) *
Email (Student)
Emergency Contact Name *
Emergency Contact Phone Number *
Student Pick Up: List of names of those approved to pick up & drop off student
Lessons: Please select the type of lesson(s) for which you're registering *
How did you hear about MoonAmie Productions? *
By submitting this form, you agree to have read and agree to all MoonAmie Productions' policies and code of conduct. *
A copy of your responses will be emailed to the address you provided.
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