HJI - Institute - registration form

Welcome

Welcome to the Helbing Jazz Institute. Please look over this registration form carefully, and fill out all the requested information.

Family main Email(*)
Please let us know your email address.

We use this email address for our main communication with you.

Student's First Name(*)
Please let us know your first name.

Student's Last Name(*)
Please let us know your last name.

Address(*)
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City(*)
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State(*)
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Zip(*)
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Date of Birth(*)
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Gender(*)
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Home Phone(*)
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Student's Cell Phone(*)
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Student's Email(*)
Please let us know your email address.


Instrument(*)
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Other Instrument
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What kind of bass do you play

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Years Playing your instrument(*)
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Playing level(*)

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School in the Fall of 2017 (if applicable)
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Grade in the Fall of 2017 (if applicable)
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Do you take private lessons?(*)
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Private teacher's name
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Preferred location and time(*)
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2nd choice location and time(*)
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Mother/Guardian Info


First Name
Please let us know your first name.

Last Name
Please let us know your last name.

Same address as student?
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Address
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City
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State
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Zip
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Mother's Cell Phone
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Mother Email
Please let us know your email address.


Father/Guardian Info


First Name
Please let us know your first name.

Last Name
Please let us know your last name.

Same address as student?
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Address
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City
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State
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Zip
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Father's Cell Phone
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Father Email
Please let us know your email address.


Message
Please let us know your message.

Tuition(*)
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