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2-Day Songwriting Workshop Registration (cc)
Student Information
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First Name
Last Name
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mm/dd/yyyy
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

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Enter grade number only
Parent Contact Information
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First Name
Last Name
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Emergency Contact Information
If the student's parents are unreachable during an emergency whom should we contact?
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First Name
Last Name
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Provide the most reliable number for this emergency contact
Musical Information
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Additional Information
Check all that apply


Ex: student excels in structured environment, student requires breaks, student is shy, etc.
Policy

To participate in Plugged In you must read, understand, and agree to the following policies.  If you have questions regarding any of the following policies please contact Plugged In directly.

Read Release of Liability / Indemnity / Emergency Treatment Agreement

Read Media Release Agreement

Read Code of Conduct Agreement

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