Student Name *

First Name

Last Name

Student Birthday *

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DD

YYYY

Primary Contact *

First Name

Last Name

Primary Contact Phone *

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Student Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Policy Agreement *

The Trophy Club Music Private Lesson Policy Agreement can be viewed by clicking the button above.

In checking this box, I acknowledge that I have read and understand Trophy Club Music's Private Lesson Policies. I agree to comply with the established guidelines.