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: | Saturday-21 Jun (10:00 - 10:50 AM) |
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 |
