| Are you signing up an: | In Person Class |
| How did you hear about us?: | Friend |
| Billing Information: | New Student |
| Contact Information: | Mother |
| First Name: | Kaitlyn |
| Last Name: | Estrella |
| Email: | kaitlynestrella@yahoo.com |
| Cell Phone: | (818) 987-9244 |
| Home Phone: | -- |
| Emergency Name: | Arturo Estrella |
| Emergency Phone: | (626) 487-9583 |
| Address: | 5846 Saloma Ave. |
| City: | Sherman Oaks |
| State: | California |
| Zipcode: | 91411 |
| Student - 1st Child: | |
| First Name: | Kassidy |
| Last Name: | Estrella |
| Allergies?: | No |
| Describe: | -- |
| Birthday: | 04/01/2020 |
| Location: | -- |
| Class: | Music Tales Book 1 (5 - 6 yrs.) |
| Class Day: | Thursday-01 Jan ( - ) |
| Child 1 (Group): | $180.00 |
| Student - 2nd Child: | |
| First Name: | -- |
| Last Name: | -- |
| Allergies?: | -- |
| Describe: | -- |
| Birthday: | -- |
| Location: | -- |
| Class: | -- |
| Class Day: | -- |
| Child 2 (Group): | $0.00 |
| Sub Total: | $180.00 |
| Discount: | $0.00 |
| Total Amount: | $180.00 |
| Payment Information: | |
| Name as it Appears on Card: | Kaitlyn Estrella |
| Type of Credit Card: | Visa |
