Keiki Kani Music Studio
ENROLLMENT
Student Full Name *
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Student Birthdate *
MM
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DD
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YYYY
Primary Contact Name (and relationship) *
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Secondary Contact Name (and relationship) *
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Best Contact Phone Number (name-# with area code) *
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Secondary Contact Phone Number (name-# with area code) *
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Alternate Contact Phone Number (name-# with area code)
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Best Email Contact Address *
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Complete Postal Mail Address *
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PREFERRED form of contact *
Who may we thank for your business?
Has the Student had previous formal music instruction? *
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