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Contact Information

First Name

Last Name

Under the age of 18

Date of Birth

Parent or Guardian Name

Phone

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Lesson Type

Type of Lessons

60 Minute Lessons

60 minute lessons

45 Minute Lessons

45 minute lessons

30 Minute Lessons

30 minute lessons

Preferred Day of Week

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Frequency

Weekly (Once Per Week)

Semi Weekly (Twice Per Week)

Single Lesson

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Total

The total cost is :

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Registration Summary

Description	Information	Quantity	Price
Discount :
Total :			/mo

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