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Thank You

A musical experience for everyone.

Thank You For Group Student Reservation.

Are you signing up an: In Person Class
How did you hear about us?: Friend
Billing Information: New Student
Contact Information: Guardian
First Name: Jignesh
Last Name: Variya
Email: haresh.ambaliya2@gmail.com
Cell Phone: (111) 111-1111
Home Phone: (222) 222-2222
Emergency Name: (444) 444-4444
Emergency Phone: (132) 131-2432
Address: Katargam
City: Surat
State: California
Zipcode: 395004
Student - 1st Child:
First Name: Hitesh
Last Name: Ambaliya
Allergies?: No
Describe: Ent
Birthday: 01/01/1990
Location: --
Class: Toddler Class -Lowey Hija 2 (3 - 4yrs.)
Class Day: Thursday-01 Jan ( - )
Child 1 (Group): $520.00
Student - 2nd Child:
First Name: bharat
Last Name: virani
Allergies?: No
Describe: test describe1
Birthday: 01/01/1995
Location: Sherman Oaks
Class: Lowey Hija 2
Class Day: Friday-28 Jan (1:00 - 1:30 PM)
Child 2 (Group): $440.00
Sub Total: $960.00
Discount: $96.00
Total Amount: $864.00
Payment Information:
Name as it Appears on Card: Haresh Ambaliya
Type of Credit Card: Visa