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Home
Welcome
Summer Classes
Sign Up!
About
Contact
Learning Music Your Way
Student and Parent Resources
Student & Parent Portal
Calendar
Studio Policies
Privacy Policy
Practice Partners
Feedback
Student Information
Student Name
*
First Name
Last Name
Date of Birth
(If under 18 yrs of age)
MM
DD
YYYY
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
School Name
Grade
Years of Experience
Primary Contact Information
Primary Contact Name
*
(Student or Parent/Guardian if under 18 yrs of age)
First Name
Last Name
Primary Contact Cell Phone
*
(###)
###
####
Primary Contact Home Phone
(###)
###
####
Primary Contact Email
*
Secondary Contact Information
Secondary Contact Name
(Student or Parent/Guardian if under 18 yrs of age)
First Name
Last Name
Secondary Contact Cell Phone
(###)
###
####
Secondary Contact Email
Additional Information
Other Phone Number
Please Specify
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone
(###)
###
####
Other Information
(Known allergies, disabilities, etc.)
How did you hear about Soltani Music?
Please check all lessons that apply:
*
Violin
Viola
Piano
Oud
