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Staff Name *

Students Full Name *

Student Under 18?

Students Date Of Birth

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(If Applicable)

Email Address *

Best Contact Number *

First Line Of Address *

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Instrument *

Days You Can Make: 1st Choice *

Days You Can Make: 2nd Choice *

Days You Can Make: 3rd Choice *

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Do You Own An Instrument? *

Yes

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Is There Anything Else You Would Like To Tell Us? *

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