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Student Name
*
First Name
Last Name
Student Birthdate
*
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Month
-
Day
Year
Date
School attending
Public
Private/parochial
Homeschool
Niles Partnership
Berrien Springs Partnership
Adult
Parent Name (if applicable)
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
phone number
*
-
Area Code
Phone Number
Enter your email address
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example@example.com
What type of music would you like to play?
Piano
Violin
Viola
Cello
Guitar
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