Suzuki Buddy Sign-Up Form

1. Contact Info *This question is required.

First Name *This question is required.

Last Name *This question is required.

Age *This question is required. This question requires a valid number format.

Grade *This question is required. This question requires a valid number format.

Birthdate *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Address *This question is required.

City *This question is required.

State *This question is required.

Zip *This question is required.

Parent Name/s *This question is required.

Email Address *This question is required. This question requires a valid email address.

Phone (day)

Phone (evening)

2. General Info

Polished Piece *This question is required.

Working Piece *This question is required.

Instrument *This question is required.

Teacher *This question is required.

Years Studied *This question is required. This question requires a valid number format.

Lesson Day & Time (e.g. M 3:00-3:45 pm) *This question is required.

Can Drive (Student or Parent)? *This question is required.

Yes	No
Yes	No

Comments

Buddy Request *This question is required.