Registration
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Welcome to Aimusic.us! Please complete the following registration form.
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Referral Information
How did you hear about us?
Facebook
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Other
Parents Magazine
Performance
Referral
Returning Family
Walk-In
Website
Referral Name
Family Information
Family Last Name
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Where do you live?
Home Address
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City
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State
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AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
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MO
MS
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OH
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OR
PA
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SD
TN
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VA
VT
WA
WI
WV
WY
PR
VI
Zip
*
Primary Phone
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Additional Info
Can employer host performance?
Contact #1
Contact #1 First Name
*
Last Name
*
Type
*
Caregiver
Child
Father
Guardian
Mother
Parent
Self
How Can We Contact You?
Home Phone
Work #
Cell #
*
Portal Access (your email is your login)
Email
*
(Emails are kept confidential)
Confirm Email
*
Portal Account Password
Confirm Portal Account Password
Who is your employer?
Employer
Employer Phone
Employer Notes
Contact #2
Contact #2 First Name
Last Name
Type
Caregiver
Child
Father
Guardian
Mother
Parent
Self
How can we contact you?
Home Phone
Work #
Cell #
Email
(Emails are kept confidential)
Confirm Email
Who is your employer?
Employer
Employer Phone
Employer Notes
Student #1
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Additional Info
Student Email
School
Nickname
Learned Music Before? How long
*
Can Play What Instrument?
*
Instrument Interested to Learn
*
Student #2
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Additional Info
Student Email
School
Nickname
Learned Music Before? How long
*
Can Play What Instrument?
*
Instrument Interested to Learn
*
Student #3
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Additional Info
Student Email
School
Nickname
Learned Music Before? How long
*
Can Play What Instrument?
*
Instrument Interested to Learn
*
Student #4
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Additional Info
Student Email
School
Nickname
Learned Music Before? How long
*
Can Play What Instrument?
*
Instrument Interested to Learn
*
Student #5
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Additional Info
Student Email
School
Nickname
Learned Music Before? How long
*
Can Play What Instrument?
*
Instrument Interested to Learn
*
Add Another Student
Required Policies
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I Agree to All of the Above
Enter your Full Name
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November 21, 2024
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