MDTEC Summer Camp Registration
Email address *
Name of Parent 1 *
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Cell Phone *
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Email Address *
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Mailing Address
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Name of Parent 2
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Email Address
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Name of Student 1 *
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Date of Birth *
MM
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DD
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YYYY
Instrument *
Current Solo Repertoire *
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Current Private Teacher *
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I will need aftercare on the following days:
Name of Student 2
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Date of Birth
MM
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DD
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YYYY
Instrument
Current Solo Repertoire
Your answer
Current Private Teacher
Your answer
Name of Student 3
Your answer
Date of Birth
MM
/
DD
/
YYYY
Instrument
Current Solo Repertoire
Your answer
Current Private Teacher
Your answer
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