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2. Date
4. First Name
   Name of Student
5. Last Name
7. Level
   -- Select One --BeginnerIntermediate BeginnerIntermediate AdvancedAdvanced
8. Age
   Age of Student
10. First Name
    Name of Student
11. Last Name
13. Level
    -- Select One --BeginnerIntermediate BeginnerIntermediate AdvancedAdvanced
14. Age
    Age of Student
16. First Name
    Parent Name
17. Last Name
19. Telephone Number
20. Day(s) requested

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
22. Date to Start Lessons
23. Number of Lessons
24. Class Time
    Enter requested class time
26. Goals for Lesson
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

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