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New Student Enrollment & Contact Form
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* Indicates required question
First Name of Student:
*
Your answer
Last Name of Student:
*
Your answer
Age
*
Your answer
Art Form of Interest:
*
Kathak Dance
Tabla
Dholak
Required
Father’s Name (required for students below 18 years)
Your answer
Mother’s Name (required for students below 18 years)
Your answer
Email address 1
*
Your answer
Email address 2
*
Your answer
Home Phone Number
Your answer
Cell Phone Number
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Cell Phone Number
*
Your answer
Is there another student enrolling from the same family?
*
Yes
No
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