Music Lotus
If you are interested in piano lessons, the first step is to fill out this form! I will be in touch with you as soon as I have received the form.
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Potential Student Information
First Name: *
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Last Name: *
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Birth Date *
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Age *
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Gender *
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School *
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Grade 2017-2018 *
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Please describe any previous piano experience:
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Parent/Guardian Information
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Last Name: *
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Address: *
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Preferred phone number: *
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E-mail: *
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Promo Code (if available):
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Comments:
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