Music & Dance
at 5th Dimension
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Inquiry and Registration Form
Student's Name & Age *
Your E-Mail Address *
Preferred Starting Date *
Name & Phone Number of Contact *
Home Address *
Preferred Schedule: Day & Time (Please Provide 3 Choices) *
PAGE 1
Piano/Violin (Private) 30 mins; 45 mins; 60 mins
Re-Enter Your E-Mail Address *
Guitar (Private) 30 mins; 45 mins; 60 mins
Vocal Private (45 mins; 60 mins) Vocal Group (60 mins)
Special Instructions and Message
PAGE 2
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