Student:
Name :		Postal Code
Address:
Telephone:		Grade
Birthday:		Gender	Male Female
Hospitalization #:
Parent/Guardian:
Name:		Relationship:
Address:		Postal Code:
Telephone:		Cell:
Email:
Class to be taken:
	Novice $275		Intermediate $350
	Beginner $300		Lileya $425
	Junior $300		Pre-Poltava $475
	Mandolin $125

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